Basic Information
Provider Information
NPI: 1689754657
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STAPLETON
FirstName: RENEE
MiddleName: DONEY
NamePrefix:  
NameSuffix:  
Credential: MD, PHD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 111 COLCHESTER AVE
Address2: ACC 5
City: BURLINGTON
State: VT
PostalCode: 054011473
CountryCode: US
TelephoneNumber: 8028471158
FaxNumber:  
Practice Location
Address1: 111 COLCHESTER AVE
Address2: ACC 5
City: BURLINGTON
State: VT
PostalCode: 054011473
CountryCode: US
TelephoneNumber: 8028471158
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/16/2006
LastUpdateDate: 10/16/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0200X042-0011436VTY Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
207RP1001X042-0011436VTN Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

No ID Information.


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