Healthcare Provider Details

I. General information

NPI: 1821028226
Provider Name (Legal Business Name): REBECCA CHLOE WINOKUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 S MAIN ST
RANDOLPH VT
05060-1381
US

IV. Provider business mailing address

PO BOX 2000
RANDOLPH VT
05060-2000
US

V. Phone/Fax

Practice location:
  • Phone: 802-728-2445
  • Fax: 802-728-2115
Mailing address:
  • Phone: 802-862-3983
  • Fax: 802-278-2445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number42-0010465
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: