Provider Demographics
NPI:1417901356
Name:DUBOFF, STUART MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:MICHAEL
Last Name:DUBOFF
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 1:322 DEWEY ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2225
Mailing Address - Country:US
Mailing Address - Phone:802-447-8700
Mailing Address - Fax:802-447-1500
Practice Address - Street 1:322 DEWEY ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2225
Practice Address - Country:US
Practice Address - Phone:802-447-8700
Practice Address - Fax:802-447-1500
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37276207W00000X
VT042-0005399207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA17154OtherMVP
VTVT0005994OtherTRICARE
MA110000245AMedicaid
VT11962OtherHNE
MA000000024103OtherBMC
MA11962OtherHNE
VTVT4364OtherVTBS
VT000000024104OtherBMC
VT10000532OtherCDPHP
MA10000532OtherCDPHP
VTI19049OtherMABS
MAVT4364OtherVTBS
VT0004364Medicaid
MAI19049OtherMABS
NY00360054Medicaid
VT17154OtherMVP
VT10000532OtherCDPHP
VT11962OtherHNE
MA110000245AMedicaid
VT17154OtherMVP
MA17154OtherMVP
NY00360054Medicaid