Healthcare Provider Details

I. General information

NPI: 1891014262
Provider Name (Legal Business Name): DUKE OSCAR KASPRISIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 W SHORE RD
SOUTH HERO VT
05486-4613
US

IV. Provider business mailing address

91 W SHORE RD
SOUTH HERO VT
05486-4613
US

V. Phone/Fax

Practice location:
  • Phone: 802-372-8983
  • Fax: 802-378-5072
Mailing address:
  • Phone: 802-372-8983
  • Fax: 802-378-5072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number39094
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number01046432A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: