Provider Demographics
NPI:1144246331
Name:TROUT, ADRIANE CROSS (MD)
Entity Type:Individual
Prefix:
First Name:ADRIANE
Middle Name:CROSS
Last Name:TROUT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ADRIANE
Other - Middle Name:
Other - Last Name:CROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:586 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7103
Mailing Address - Country:US
Mailing Address - Phone:802-878-8131
Mailing Address - Fax:802-879-6853
Practice Address - Street 1:586 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7103
Practice Address - Country:US
Practice Address - Phone:802-878-8131
Practice Address - Fax:802-879-6853
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239668207Q00000X
VT042-0012540207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY239668Medicaid
VT1021460Medicaid
NY02835472Medicaid
VT1021460Medicaid
NY02835472Medicaid
NYJ400004314Medicare PIN