=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336891118
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTONY LEHTIKOSKI
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2022
-----------------------------------------------------
Last Update Date | 12/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 98 HOSPITALITY DR
-----------------------------------------------------
City | BARRE
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05641-5360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-229-0308
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 SPRING ST APT 2
-----------------------------------------------------
City | MONTPELIER
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05602-2288
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-774-6416
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | MA063427
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 055.0031808
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number | 25MP00708300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------