Healthcare Provider Details

I. General information

NPI: 1376596478
Provider Name (Legal Business Name): CHRISTINE M. STAATS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 EAST MALLETTS BAY AVE.
WINOOSKI VT
05404
US

IV. Provider business mailing address

32 EAST MALLETTS BAY AVE.
WINOOSKI VT
05404
US

V. Phone/Fax

Practice location:
  • Phone: 802-655-4422
  • Fax:
Mailing address:
  • Phone: 802-655-4422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0420010953
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: