Provider Demographics
NPI:1013274745
Name:CHAMPLAIN IMAGING
Entity Type:Organization
Organization Name:CHAMPLAIN IMAGING
Other - Org Name:CHAMPLAIN IMAGING, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPATINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-524-1209
Mailing Address - Street 1:PO BOX 8002
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-8002
Mailing Address - Country:US
Mailing Address - Phone:800-927-0002
Mailing Address - Fax:603-893-8886
Practice Address - Street 1:133 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1726
Practice Address - Country:US
Practice Address - Phone:800-927-0002
Practice Address - Fax:603-893-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT102151Medicaid