1710170725 NPI number — LEONARD TREMBLAY, MD PLC

Table of content: (NPI 1710170725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710170725 NPI number — LEONARD TREMBLAY, MD PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEONARD TREMBLAY, MD PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1710170725
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
53 FAIRFAX RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT ALBANS
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05478-4405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-524-3215
Provider Business Mailing Address Fax Number:
802-442-4778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
53 FAIRFAX RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT ALBANS
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05478-4405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-524-3215
Provider Business Practice Location Address Fax Number:
802-442-4778
Provider Enumeration Date:
08/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TREMBLAY
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF ADMINISTRATOR
Authorized Official Telephone Number:
802-524-3215

Provider Taxonomy Codes

  • Taxonomy code: 207VX0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1014193 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: DH1206 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com