Provider Demographics
NPI:1568479251
Name:ANDERSON, KRISTOFER E (MD)
Entity Type:Individual
Prefix:
First Name:KRISTOFER
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:104 PORTER DR
Mailing Address - Street 2:PORTER PRACTICE MANAGEMENT
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-8527
Mailing Address - Country:US
Mailing Address - Phone:802-388-8808
Mailing Address - Fax:802-388-8322
Practice Address - Street 1:1330 EXCHANGE ST
Practice Address - Street 2:SUITE 202 PORTER ENT
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-4425
Practice Address - Country:US
Practice Address - Phone:802-388-7037
Practice Address - Fax:802-388-5657
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2008-05-13
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Provider Licenses
StateLicense IDTaxonomies
VT0420011127207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012756Medicaid
VTVN4078Medicare PIN
I64904Medicare UPIN