MEDICARE: DR. JUSTIN KARLITZ-GRODIN 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	042-0011992	VT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	001708701	OTHER	VT	MEDICARE PTAN LINKED TO CVMC MGP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275651549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN KARLITZ-GRODIN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 547
Second Line	:	CENTRAL VERMONT MEDICAL CENTER-FINANCE DEPT
City	:	BARRE
State	:	VT
Zip	:	05641-0547
Country	:	US
Telephone Number	:	802-244-7874
Fax Number	:	802-244-4106

Provider Business Practice Location Address
First Line	:	130 S MAIN ST
Second Line	:	CVMC FAMILY MEDICINE-WATEBURY
City	:	WATERBURY
State	:	VT
Zip	:	05676-1519
Country	:	US
Telephone Number	:	802-244-7874
Fax Number	:	802-244-4106

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	11/17/2023

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