Provider Demographics
NPI:1801945373
Name:VANUITERT, ROBERT LEGRANDE
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEGRANDE
Last Name:VANUITERT
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 1:77 HOSPITAL AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-2550
Mailing Address - Country:US
Mailing Address - Phone:413-664-6321
Mailing Address - Fax:413-663-9208
Practice Address - Street 1:77 HOSPITAL AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-2550
Practice Address - Country:US
Practice Address - Phone:413-664-6321
Practice Address - Fax:413-663-9208
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA455702084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0140554Medicaid
MA0140554Medicaid
MAA55691Medicare UPIN