LAKE CHAMPLAIN GYNECOLOGIC ONCOLOGY PC NPI 1164418455

NPI Information

NPI: 1164418455
Provider Name: LAKE CHAMPLAIN GYNECOLOGIC ONCOLOGY, PC
Classification: Obstetrics & Gynecology - 207VX0201X
Entity Type: Organization

Specialization: Gynecologic Oncology

CLIA Number: 47D1003387

Address:
1060 HINESBURG RD
SUITE 301
SOUTH BURLINGTON, VT
ZIP 05403
Phone: (802) 859-9500
Get Directions

LAKE CHAMPLAIN GYNECOLOGIC ONCOLOGY, PC is a gynecologic oncology obstetrics gynecology in South Burlington, VT. The provider is an obstetrician/gynecologist who provides consultation and comprehensive management of patients with gynecologic cancer, including those diagnostic and therapeutic procedures necessary for the total care of the patient with gynecologic cancer and resulting complications. LAKE CHAMPLAIN GYNECOLOGIC ONCOLOGY, PC NPI is 1164418455. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1060 HINESBURG RD
SUITE 301
SOUTH BURLINGTON, VT
ZIP 05403-612
Phone: (802) 859-9500
Fax: (802) 859-9944

The provider's authorized official is Gamal H Eltabbakh .
The authorized official title is President and has the following contact phone number (802) 859-9500.

The CLIA number assigned to this NPI record is 47D1003387 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 9/22/2005 and was last updated on 5/23/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	363A00000X	Physician Assistant		No
2	363L00000X	Nurse Practitioner		No
3	207VX0201X	Obstetrics & Gynecology	Gynecologic Oncology	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	AA1688	MEDICARE PIN	NEW YORK
2	1008935	MEDICAID	VERMONT
3	01760585	MEDICAID	NEW YORK
4	VN2936	MEDICARE PIN	VERMONT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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