Provider Demographics
NPI:1356871792
Name:ODIGIE, IAN (DPM)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:ODIGIE
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 1:69 ALLEN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4564
Mailing Address - Country:US
Mailing Address - Phone:802-773-8199
Mailing Address - Fax:802-773-7974
Practice Address - Street 1:69 ALLEN ST STE 6
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4564
Practice Address - Country:US
Practice Address - Phone:802-773-8199
Practice Address - Fax:802-773-7974
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT056.0000197213ES0103X
PASC006803213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery