Provider Demographics
NPI:1003985821
Name:DTGC, PC
Entity Type:Organization
Organization Name:DTGC, PC
Other - Org Name:VERMONT DERMATOPATHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:MURER
Authorized Official - Last Name:ANTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-658-6269
Mailing Address - Street 1:30 FARRELL ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6112
Mailing Address - Country:US
Mailing Address - Phone:802-658-6269
Mailing Address - Fax:802-860-4642
Practice Address - Street 1:30 FARRELL ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6112
Practice Address - Country:US
Practice Address - Phone:802-658-6269
Practice Address - Fax:802-860-4642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2726Medicaid
DTVN2726Medicare ID - Type Unspecified