Provider Demographics
NPI:1184112062
Name:BUHL, ETHAN ANDREW (DPM)
Entity type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:ANDREW
Last Name:BUHL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 GREEN ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6054
Mailing Address - Country:US
Mailing Address - Phone:607-237-2317
Mailing Address - Fax:
Practice Address - Street 1:19 BELMONT AVE OFC BUILDING
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-7109
Practice Address - Country:US
Practice Address - Phone:802-251-8650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT056.0000198213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3124378Medicaid
VT6704439Medicaid