Healthcare Provider Details

I. General information

NPI: 1851633903
Provider Name (Legal Business Name): REBECCA ELIZABETH KINCAID MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 S MAIN ST
RANDOLPH VT
05060-1377
US

IV. Provider business mailing address

PO BOX 2000
RANDOLPH VT
05060-2000
US

V. Phone/Fax

Practice location:
  • Phone: 802-728-2420
  • Fax: 802-728-2111
Mailing address:
  • Phone: 802-728-7000
  • Fax: 802-728-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9149531-1205
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9149531-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: