Provider Demographics
NPI:1619266624
Name:FLETCHER ALLEN HEALTH CARE INC
Entity Type:Organization
Organization Name:FLETCHER ALLEN HEALTH CARE INC
Other - Org Name:FAHC RADIATION ONCOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:DESHAIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-847-5911
Mailing Address - Street 1:PO BOX 1063
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05402-1063
Mailing Address - Country:US
Mailing Address - Phone:802-847-1882
Mailing Address - Fax:802-847-6254
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLETCHER ALLEN HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT7482085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty