Provider Demographics
NPI:1003857178
Name:FELSTED, LAURA ALLEN (DO)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ALLEN
Last Name:FELSTED
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:S
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:CENTRAL VERMONT MEDICAL CENTER - FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-225-5400
Mailing Address - Fax:802-225-5401
Practice Address - Street 1:130 FISHER RD STE 3
Practice Address - Street 2:MOUNTAINVIEW MEDICAL
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9516
Practice Address - Country:US
Practice Address - Phone:802-225-5400
Practice Address - Fax:802-225-5401
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT032-0000524207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011620Medicaid
VT1011620Medicaid
OX1083Medicare PIN
VTVN3729Medicare PIN
VT1011620Medicaid