Provider Demographics
NPI:1669499430
Name:GADD, JUSTINE (PA)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:GADD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:CENTRAL VERMONT MEDICAL CENTER - FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-225-5810
Mailing Address - Fax:802-371-4821
Practice Address - Street 1:246 GRANGER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9516
Practice Address - Country:US
Practice Address - Phone:802-225-5810
Practice Address - Fax:802-371-4821
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055-0030702363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT9000196Medicaid
AP2186Medicare ID - Type Unspecified
Q20609Medicare UPIN
AP2186Medicare ID - Type Unspecified