MEDICARE: DR. ANJE C VANBERCKELAER M. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A93304	CA
2	207Q00000X	Family Medicine Physician	MD434212	PA
3	207Q00000X	Family Medicine Physician	042.0013693	VT

General Provider Information

NPI Number	:	1174654479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANJE C VANBERCKELAER M. D.

Provider Business Mailing Address
First Line	:	PO BOX 61
Second Line	:
City	:	ARLINGTON
State	:	VT
Zip	:	05250-0061
Country	:	US
Telephone Number	:	802-375-6566
Fax Number	:	802-375-6828

Provider Business Practice Location Address
First Line	:	9 CHURCH ST
Second Line	:
City	:	ARLINGTON
State	:	VT
Zip	:	05250-4457
Country	:	US
Telephone Number	:	802-375-6566
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	05/11/2023

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