Provider Demographics
NPI:1336215698
Name:HESSE, FREDERICK
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:HESSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 STRATTON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4892
Mailing Address - Country:US
Mailing Address - Phone:802-775-7798
Mailing Address - Fax:802-775-7762
Practice Address - Street 1:199 STRATTON RD STE 1
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4892
Practice Address - Country:US
Practice Address - Phone:802-775-7798
Practice Address - Fax:802-775-7762
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0013651207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD80790Medicare UPIN