Provider Demographics
NPI:1649233164
Name:VLP INCORPORATED
Entity Type:Organization
Organization Name:VLP INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIJA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEISTRUP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-743-1562
Mailing Address - Street 1:PO BOX 790056
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-0056
Mailing Address - Country:US
Mailing Address - Phone:314-989-0300
Mailing Address - Fax:
Practice Address - Street 1:181 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5664
Practice Address - Country:US
Practice Address - Phone:207-743-1562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016515207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME11213865OtherPEISTRUP-CAQH
MEE54144Medicare UPIN
MEME0546Medicare ID - Type UnspecifiedPEISTRUP