Provider Demographics
NPI:1780684902
Name:OGISTE, ESTELA VALERIAN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ESTELA
Middle Name:VALERIAN
Last Name:OGISTE
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 DEWEY ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2225
Mailing Address - Country:US
Mailing Address - Phone:802-447-8700
Mailing Address - Fax:802-447-1500
Practice Address - Street 1:77 HOSPITAL AVE STE 110
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-2592
Practice Address - Country:US
Practice Address - Phone:413-664-6736
Practice Address - Fax:413-664-7349
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0014908207W00000X
NY213367207W00000X
MA151207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02166801Medicaid
NY02166801Medicaid