Healthcare Provider Details

I. General information

NPI: 1912901588
Provider Name (Legal Business Name): KATHRYN LEOPOLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 WILLISTON RD STE 110
SOUTH BURLINGTON VT
05403-6491
US

IV. Provider business mailing address

1775 WILLISTON RD STE 110
SOUTH BURLINGTON VT
05403-6491
US

V. Phone/Fax

Practice location:
  • Phone: 802-735-1252
  • Fax:
Mailing address:
  • Phone: 802-735-1252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number207916-3
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: