Provider Demographics
NPI:1154403996
Name:CHAMPLAIN VALLEY ORTHOPEDICS
Entity type:Organization
Organization Name:CHAMPLAIN VALLEY ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDICS SURGEON/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-388-3194
Mailing Address - Street 1:1436 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-1185
Mailing Address - Country:US
Mailing Address - Phone:802-388-3194
Mailing Address - Fax:802-388-4881
Practice Address - Street 1:1436 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1185
Practice Address - Country:US
Practice Address - Phone:802-388-3194
Practice Address - Fax:802-388-4881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420008791261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTF67144Medicare UPIN
VTR17681Medicare UPIN
VTVN2977Medicare ID - Type Unspecified
VTH67913Medicare UPIN