Provider Demographics
NPI:1275651549
Name:KARLITZ-GRODIN, JUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:KARLITZ-GRODIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:CENTRAL VERMONT MEDICAL CENTER-FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-244-7874
Mailing Address - Fax:802-244-4106
Practice Address - Street 1:130 S MAIN ST
Practice Address - Street 2:CVMC FAMILY MEDICINE-WATEBURY
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676-1519
Practice Address - Country:US
Practice Address - Phone:802-244-7874
Practice Address - Fax:802-244-4106
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT042-0011992207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1017745Medicaid
VT001708701OtherMEDICARE PTAN LINKED TO CVMC MGP