Provider Demographics
NPI:1861676389
Name:RICHARD S. DONELA
Entity Type:Organization
Organization Name:RICHARD S. DONELA
Other - Org Name:TRI-STATE PODIATRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:DONELA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:802-442-8448
Mailing Address - Street 1:213 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2510
Mailing Address - Country:US
Mailing Address - Phone:802-442-8448
Mailing Address - Fax:
Practice Address - Street 1:213 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2510
Practice Address - Country:US
Practice Address - Phone:802-442-8448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT89213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0008312Medicaid
VTT25419Medicare UPIN
VT0008312Medicaid
VT0931870001Medicare NSC