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General NPI Number Information
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NPI Number | 1528154697
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Entity Type | Individual
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Provider Name | JOHN G KOUTRAS M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 1 S PROSPECT ST
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City | BURLINGTON
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State | VT
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Zip | 05401-3456
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Country | US
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Telephone | 802-847-4560
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Fax | 802-847-8747
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Provider Business Mailing Address
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Address Line | 71 ELK LN
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City | WILLISTON
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State | VT
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Zip | 05495-4412
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Country | US
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Telephone | 802-878-2383
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 042.0010844
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License Number State | VT
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