Provider Demographics
NPI:1609067156
Name:SAPAROFF, GERALD ROBIN (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:ROBIN
Last Name:SAPAROFF
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 1:212 PROUTY DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855
Mailing Address - Country:US
Mailing Address - Phone:802-334-8002
Mailing Address - Fax:802-334-9136
Practice Address - Street 1:212 PROUTY DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855
Practice Address - Country:US
Practice Address - Phone:802-334-8002
Practice Address - Fax:802-334-9136
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042 0005731207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0005351Medicaid
VT0005351Medicaid
VT4694Medicare PIN