Provider Demographics
NPI:1164491221
Name:HUBER, DANIEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:C
Last Name:HUBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:VERGENNES
Mailing Address - State:VT
Mailing Address - Zip Code:05491-1107
Mailing Address - Country:US
Mailing Address - Phone:802-877-3466
Mailing Address - Fax:802-877-1188
Practice Address - Street 1:10 NORTH ST
Practice Address - Street 2:
Practice Address - City:VERGENNES
Practice Address - State:VT
Practice Address - Zip Code:05491-1107
Practice Address - Country:US
Practice Address - Phone:802-877-3466
Practice Address - Fax:802-877-1188
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039959207Q00000X
VT042-0012421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT01399593Medicaid
CT01399593Medicaid
CT080001519Medicare ID - Type Unspecified