Provider Demographics
NPI:1801973334
Name:CALOBRISI, VIVIAN M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:M
Last Name:CALOBRISI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MEDICAL VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-9835
Mailing Address - Country:US
Mailing Address - Phone:802-334-3504
Mailing Address - Fax:802-334-3512
Practice Address - Street 1:41 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-9835
Practice Address - Country:US
Practice Address - Phone:802-334-3504
Practice Address - Fax:802-334-3512
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0550030279363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0002510Medicaid
VT118505OtherMVP
VT00028004OtherBLUE SHIELD
VT8000219OtherLADIES FIRST
VTP00055182OtherRAILROAD MEDICARE
VTP00055182OtherRAILROAD MEDICARE
VT0002510Medicaid