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General NPI Number Information
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NPI Number | 1275651549
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Entity Type | Individual
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Provider Name | JUSTIN KARLITZ-GRODIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 130 S MAIN ST CVMC FAMILY MEDICINE-WATEBURY
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City | WATERBURY
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State | VT
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Zip | 05676-1519
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Country | US
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Telephone | 802-244-7874
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Fax | 802-244-4106
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Provider Business Mailing Address
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Address Line | PO BOX 547 CENTRAL VERMONT MEDICAL CENTER-FINANCE DEPT
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City | BARRE
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State | VT
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Zip | 05641-0547
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Country | US
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Telephone | 802-244-7874
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Fax | 802-244-4106
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 042-0011992
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License Number State | VT
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