Provider Demographics
NPI:1346241734
Name:ZELAZO, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ZELAZO
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 1:1862 HIGHGATE RD
Mailing Address - Street 2:
Mailing Address - City:ST ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-8091
Mailing Address - Country:US
Mailing Address - Phone:802-868-2454
Mailing Address - Fax:802-868-2461
Practice Address - Street 1:45 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SWANTON
Practice Address - State:VT
Practice Address - Zip Code:05488-1434
Practice Address - Country:US
Practice Address - Phone:802-868-2454
Practice Address - Fax:802-868-2461
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420006142207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0002358Medicaid
VT00028916OtherBCBS
VTVT2358Medicare ID - Type Unspecified
VTB85389Medicare UPIN
VTVN0879Medicare PIN
VT0002358Medicaid