1306800081 NPI number — MARIE L ZAGROBA M.D.

Table of content: MARIE L ZAGROBA M.D. (NPI 1306800081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306800081 NPI number — MARIE L ZAGROBA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZAGROBA
Provider First Name:
MARIE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306800081
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 297
Provider Second Line Business Mailing Address:
6971 MAIN STREET
Provider Business Mailing Address City Name:
WAITSFIELD
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05673-0297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-496-6161
Provider Business Mailing Address Fax Number:
802-496-6170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 FISHER RD
Provider Second Line Business Practice Location Address:
CENTRAL VT MEDICAL CENTER
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05602-9516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-371-4257
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  042-0008339 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00018091 . This is a "VERMONT BLUECROSS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: VN0169 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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