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General NPI Number Information
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NPI Number | 1629241336
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Entity Type | Individual
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Provider Name | DMITRIY GRIGORIY AKSELROD M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 05/08/2017
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Provider Practice Location Address
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Address Line | 111 COLCHESTER AVE UVM MEDICAL CENTER, DEPT OF RADIOLOGY
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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 | 802-847-2030
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Fax | 802-847-8493
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Provider Business Mailing Address
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Address Line | 111 COLCHESTER AVE UVM MEDICAL CENTER, DEPT OF RADIOLOGY
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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 | 802-847-2030
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Fax | 802-847-8493
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD60346655
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | M-12281
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 042.0012073
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License Number State | VT
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