Provider Demographics
NPI:1891775169
Name:NESBIT, ROBERT DAVID (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVID
Last Name:NESBIT
Suffix:
Gender:M
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 1063
Mailing Address - Street 2:FAHC
Mailing Address - City:BULINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05402-1063
Mailing Address - Country:US
Mailing Address - Phone:802-847-3340
Mailing Address - Fax:802-847-7083
Practice Address - Street 1:354 MOUNTAIN VIEW DR
Practice Address - Street 2:FAHC PLASTIC SURGERY
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446
Practice Address - Country:US
Practice Address - Phone:802-847-3340
Practice Address - Fax:802-847-7083
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT04200110532086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012110Medicaid
NY02709662Medicaid
VTVN3899Medicare ID - Type Unspecified
NY02709662Medicaid