Provider Demographics
NPI:1376573881
Name:JANIK, DALE S (MD)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:S
Last Name:JANIK
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 1:1 ALBERT CREE DR
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4674
Mailing Address - Country:US
Mailing Address - Phone:802-786-1400
Mailing Address - Fax:802-786-1405
Practice Address - Street 1:1 ALBERT CREE DR
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4674
Practice Address - Country:US
Practice Address - Phone:802-786-1400
Practice Address - Fax:802-786-1405
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD202928207RG0100X
VT0420008044207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT10139OtherMVP
OR500790716Medicaid
VT0058911OtherBCBS
VTOVN0078Medicaid
VT10139OtherMVP