MEDICARE: STEPHANIE J LANDVATER MD

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	207X00000X	Orthopaedic Surgery Physician	042000860	VT

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	18693	OTHER	VT	BLUE CROSS/BLUE SHIELD/VT
4	18304	OTHER	VT	MVP

General Provider Information

NPI Number	:	1689662215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE J LANDVATER MD

Provider Business Mailing Address
First Line	:	507 CHAPMAN LN
Second Line	:
City	:	WILLISTON
State	:	VT
Zip	:	05495-7770
Country	:	US
Telephone Number	:	802-881-5137
Fax Number	:	802-433-5070

Provider Business Practice Location Address
First Line	:	2418 AIRPORT RD STE C
Second Line	:
City	:	BARRE
State	:	VT
Zip	:	05641-8702
Country	:	US
Telephone Number	:	802-881-5137
Fax Number	:	802-433-5070

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

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	07/18/2019

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