Provider Demographics
NPI:1922114164
Name:SURATT, BENJAMIN TATE (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:TATE
Last Name:SURATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6 DEER CROSSING LN
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3410
Mailing Address - Country:US
Mailing Address - Phone:802-656-8979
Mailing Address - Fax:802-656-8989
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:FAHC, PATRICK 204
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-656-8979
Practice Address - Fax:802-656-8989
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT042-0010401207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine