Provider Demographics
NPI:1407889769
Name:TRABULSY, MARIO ESTRIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:ESTRIN
Last Name:TRABULSY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 BRAELOCH RD
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-7478
Mailing Address - Country:US
Mailing Address - Phone:802-893-7624
Mailing Address - Fax:
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:FAHC EMERGENCY DEPARTMENT
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-3982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT42-0009271207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN1360Medicaid
VTTRVN1360Medicare ID - Type Unspecified
NYE01654815Medicare ID - Type Unspecified
VTF82460Medicare UPIN