Provider Demographics
NPI:1265543136
Name:STURTEVANT, ALLISON (MD)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:
Last Name:STURTEVANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 PROUTY DR
Mailing Address - Street 2:EMERGENCY DEPT
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-9326
Mailing Address - Country:US
Mailing Address - Phone:802-334-4111
Mailing Address - Fax:802-334-3281
Practice Address - Street 1:189 PROUTY DR
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-9326
Practice Address - Country:US
Practice Address - Phone:802-334-4111
Practice Address - Fax:802-334-3281
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0010251207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN2619Medicaid
VT00058266OtherBLUE SHIELD
H42006Medicare UPIN
VTVN2619Medicare ID - Type Unspecified