Provider Demographics
NPI:1497790950
Name:PINTER, ELLEN RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:RENEE
Last Name:PINTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 710
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-0710
Mailing Address - Country:US
Mailing Address - Phone:802-886-2526
Mailing Address - Fax:802-886-2225
Practice Address - Street 1:368 RIVER ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-2242
Practice Address - Country:US
Practice Address - Phone:802-886-2526
Practice Address - Fax:802-886-2225
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055-0030008363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT9000088Medicaid
S31400Medicare UPIN
AP0505Medicare ID - Type Unspecified