MEDICARE: ESTELA VALERIAN OGISTE MD, PHD

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	207W00000X	Ophthalmology Physician	042.0014908	VT
2	207W00000X	Ophthalmology Physician	213367	NY
3	207W00000X	Ophthalmology Physician	151	MA

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	:	1780684902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTELA VALERIAN OGISTE MD, PHD

Provider Business Mailing Address
First Line	:	322 DEWEY ST
Second Line	:
City	:	BENNINGTON
State	:	VT
Zip	:	05201-2225
Country	:	US
Telephone Number	:	802-447-8700
Fax Number	:	802-447-1500

Provider Business Practice Location Address
First Line	:	77 HOSPITAL AVE STE 110
Second Line	:
City	:	NORTH ADAMS
State	:	MA
Zip	:	01247-2592
Country	:	US
Telephone Number	:	413-664-6736
Fax Number	:	413-664-7349

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	11/11/2020

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