Basic Information
Provider Information
NPI: 1538553656
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GILLETT
FirstName: SARAH
MiddleName: RUTH
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 111 COLCHESTER AVE
Address2: MAILSTOP 156SM2
City: BURLINGTON
State: VT
PostalCode: 054011473
CountryCode: US
TelephoneNumber: 8028474953
FaxNumber:  
Practice Location
Address1: 111 COLCHESTER AVE
Address2: MAILSTOP 156SM2
City: BURLINGTON
State: VT
PostalCode: 054011473
CountryCode: US
TelephoneNumber: 8028472700
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/26/2015
LastUpdateDate: 12/08/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/08/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0000X042-0015596VTN Allopathic & Osteopathic PhysiciansInternal MedicineHematology
208M00000X042-0015596VTN Allopathic & Osteopathic PhysiciansHospitalist 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207RX0202X042-0015596VTY Allopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology

No ID Information.


Home