Provider Demographics
NPI:1073549945
Name:AITKEN, PHIL ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:PHIL
Middle Name:ALLEN
Last Name:AITKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:55 TIMBER LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-5201
Mailing Address - Country:US
Mailing Address - Phone:802-652-0717
Mailing Address - Fax:802-652-0798
Practice Address - Street 1:55 TIMBER LN
Practice Address - Street 2:SUITE C
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-5201
Practice Address - Country:US
Practice Address - Phone:802-652-0717
Practice Address - Fax:802-652-0798
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420005259207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
19833OtherBLSH
VT0004799Medicaid
17V300OtherMVP
17V300OtherMVP
PHVN1704Medicare ID - Type Unspecified