Healthcare Provider Details

I. General information

NPI: 1225016793
Provider Name (Legal Business Name): ALEXANDRA BARSTOW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 GRAFTON RD
TOWNSHEND VT
05353
US

IV. Provider business mailing address

PO BOX 216
TOWNSHEND VT
05353-0216
US

V. Phone/Fax

Practice location:
  • Phone: 802-365-4331
  • Fax: 802-365-7031
Mailing address:
  • Phone: 802-365-4331
  • Fax: 802-365-7031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number042-0010972
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: