Provider Demographics
NPI:1609890896
Name:FINE, JEFFREY BARTON (PA-C)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BARTON
Last Name:FINE
Suffix:
Gender:M
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 1:3899 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05455-9656
Mailing Address - Country:US
Mailing Address - Phone:802-827-3667
Mailing Address - Fax:
Practice Address - Street 1:9 CREST RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-9701
Practice Address - Country:US
Practice Address - Phone:802-527-0753
Practice Address - Fax:802-524-2695
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055-0030897363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0AP1170Medicaid
FIAP1170Medicare ID - Type Unspecified
VT0AP1170Medicaid