Provider Demographics
NPI:1053651760
Name:DESZYNSKI, CHRISTOPHER M
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:M
Last Name:DESZYNSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:CHRISTOPHER
Other - Middle Name:M
Other - Last Name:DESZYNSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:73 MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-3909
Mailing Address - Country:US
Mailing Address - Phone:802-579-1679
Mailing Address - Fax:802-579-1674
Practice Address - Street 1:73 MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301
Practice Address - Country:US
Practice Address - Phone:802-579-1679
Practice Address - Fax:802-579-1674
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0124373175F00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No175F00000XOther Service ProvidersNaturopath