Provider Demographics
NPI:1437242005
Name:ROLAND, THOMAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:ROLAND
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 1:2015 DORSET ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:VT
Mailing Address - Zip Code:05445-9240
Mailing Address - Country:US
Mailing Address - Phone:802-425-2949
Mailing Address - Fax:802-847-2386
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:SHEPARDSON 2
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-3506
Practice Address - Fax:802-847-2386
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT04200062982085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0004343Medicaid
VT4343Medicare ID - Type Unspecified
VT0004343Medicaid