Healthcare Provider Details

I. General information

NPI: 1245265909
Provider Name (Legal Business Name): MARC S KUTLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 FAIRFIELD ST
SAINT ALBANS VT
05478-1726
US

IV. Provider business mailing address

133 FAIRFIELD ST
SAINT ALBANS VT
05478-1726
US

V. Phone/Fax

Practice location:
  • Phone: 802-524-1050
  • Fax: 802-524-1057
Mailing address:
  • Phone: 802-524-1050
  • Fax: 802-524-1057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number0420007186
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: