Provider Demographics
NPI:1649216268
Name:RAINBOW PEDIATRICS
Entity Type:Organization
Organization Name:RAINBOW PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-388-1338
Mailing Address - Street 1:44 COLLINS DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-8528
Mailing Address - Country:US
Mailing Address - Phone:802-388-1338
Mailing Address - Fax:802-388-8244
Practice Address - Street 1:44 COLLINS DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-8528
Practice Address - Country:US
Practice Address - Phone:802-388-1338
Practice Address - Fax:802-388-8244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT39687OtherBCVT GROUP NUMBER
VT1287939OtherCIGNA GROUP NUMBER
VT1006825Medicaid