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General NPI Number Information
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NPI Number | 1356374755
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Entity Type | Individual
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Provider Name | WALLACE KEMPER ALSTON MD
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Gender | Male
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 111 COLCHESTER AVE
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City | BURLINGTON
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State | VT
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Zip | 05401-1473
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Country | US
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Telephone | 802-847-4835
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Fax | 802-847-5322
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Provider Business Mailing Address
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Address Line | 106 COLCHESTER AVE
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City | BURLINGTON
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State | VT
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Zip | 05401-1417
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Country | US
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Telephone | 802-847-4835
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Fax | 802-847-5322
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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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 042.0008736
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License Number State | VT
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