Provider Demographics
NPI:1720007800
Name:PINN, ELKE (MD)
Entity Type:Individual
Prefix:
First Name:ELKE
Middle Name:
Last Name:PINN
Suffix:
Gender:F
Credentials:MD
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 297
Mailing Address - Street 2:
Mailing Address - City:WAITSFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05673-0297
Mailing Address - Country:US
Mailing Address - Phone:802-496-6161
Mailing Address - Fax:802-496-6170
Practice Address - Street 1:130 FISHER RD
Practice Address - Street 2:CENTRAL VERMONT MEDICAL CENTER
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9516
Practice Address - Country:US
Practice Address - Phone:802-371-4257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0008560207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00019086OtherBLUE CROSS
VTOVN0642Medicaid
VTOVN0642Medicaid
VTVN0642Medicare ID - Type Unspecified