Provider Demographics
NPI:1780665471
Name:CENTRAL VERMONT UROLOGY INC
Entity Type:Organization
Organization Name:CENTRAL VERMONT UROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ZAHM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-476-6060
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-0278
Mailing Address - Country:US
Mailing Address - Phone:802-476-6060
Mailing Address - Fax:802-476-6767
Practice Address - Street 1:542 BARRE MONTPELIER RD
Practice Address - Street 2:US RT 302
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641
Practice Address - Country:US
Practice Address - Phone:802-476-6060
Practice Address - Fax:802-476-6767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420006490208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CM5214OtherRAIL ROAD MEDICARE
VT0009493Medicaid
CM5214OtherRAIL ROAD MEDICARE
B85655Medicare UPIN