Provider Demographics
NPI:1821592387
Name:STEPHANIE LANDVATER, MD PLC
Entity Type:Organization
Organization Name:STEPHANIE LANDVATER, MD PLC
Other - Org Name:STEPHANIE LANDVATER, MD PLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANDVATER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-881-5137
Mailing Address - Street 1:507 CHAPMAN LN
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7770
Mailing Address - Country:US
Mailing Address - Phone:802-881-5137
Mailing Address - Fax:802-433-5070
Practice Address - Street 1:2418 AIRPORT RD STE C
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641
Practice Address - Country:US
Practice Address - Phone:802-881-5137
Practice Address - Fax:802-433-5070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN0439Medicaid