Provider Demographics
NPI:1538329065
Name:KOLB, AMANDA E (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:E
Last Name:KOLB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:E
Other - Last Name:MALGARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:790 COLLEGE PKWY
Mailing Address - Street 2:UVM MEDICAL CENTER - FAMILY MEDICINE (WICC)
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-3007
Mailing Address - Country:US
Mailing Address - Phone:802-847-1170
Mailing Address - Fax:802-847-7559
Practice Address - Street 1:790 COLLEGE PKWY
Practice Address - Street 2:UVM MEDICAL CENTER - FAMILY MEDICINE (WICC)
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-3007
Practice Address - Country:US
Practice Address - Phone:802-847-1170
Practice Address - Fax:802-847-7559
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101249880207Q00000X
VT042.0013351207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program