Healthcare Provider Details

I. General information

NPI: 1982282216
Provider Name (Legal Business Name): VERONICA CHARLOTTE PETERKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
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 Number303409
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: