Healthcare Provider Details

I. General information

NPI: 1003985821
Provider Name (Legal Business Name): DTGC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 FARRELL ST SUITE 202
SOUTH BURLINGTON VT
05403-6112
US

IV. Provider business mailing address

30 FARRELL ST SUITE 202
SOUTH BURLINGTON VT
05403-6112
US

V. Phone/Fax

Practice location:
  • Phone: 802-658-6269
  • Fax: 802-860-4642
Mailing address:
  • Phone: 802-658-6269
  • Fax: 802-860-4642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE MURER ANTLEY
Title or Position: PRESIDENT
Credential: MD
Phone: 802-658-6269