Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 042-0009116 | VT |
NPI | 1114983350 |
---|---|
Provider Name | Dr. Patrice Peterson Colander |
First Address | Middlebury, VT 05753-8528 |
Second Address | Middlebury, VT 05753-8528 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26P882 | MVP (01) | |
38707 | BCVT (01) | |
G72008 | (02) |