Healthcare Provider Details

I. General information

NPI: 1942567078
Provider Name (Legal Business Name): JOHANN ENTINGER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 ALLEN ST STE 1
RUTLAND VT
05701-4564
US

IV. Provider business mailing address

69 ALLEN ST STE 1
RUTLAND VT
05701-4564
US

V. Phone/Fax

Practice location:
  • Phone: 802-773-8199
  • Fax: 802-773-7974
Mailing address:
  • Phone: 802-773-8199
  • Fax: 802-773-7974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number056.0000205
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: