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General NPI Number Information
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NPI Number | 1811948847
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Entity Type | Individual
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Provider Name | STEPHEN S KORNBLUTH M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 09/02/2016
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Provider Practice Location Address
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Address Line | 275 ROUTE 30 N
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City | BOMOSEEN
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State | VT
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Zip | 05732-9647
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Country | US
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Telephone | 802-468-5641
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Fax | 802-468-2923
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Provider Business Mailing Address
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Address Line | 71 ALLEN STREET SUITE 403
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City | RUTLAND
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State | VT
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Zip | 05701-4570
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Country | US
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Telephone | 802-772-4414
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Fax | 802-772-7973
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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 | 153606
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0420011399
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License Number State | VT
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