Provider Demographics
NPI:1336404722
Name:VOGT, CHRISTOPHER TYLER (DO)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:TYLER
Last Name:VOGT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3234
Mailing Address - Country:US
Mailing Address - Phone:802-404-1350
Mailing Address - Fax:802-404-1385
Practice Address - Street 1:87 MAIN ST
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3234
Practice Address - Country:US
Practice Address - Phone:802-404-1350
Practice Address - Fax:802-404-1385
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO 00779207Q00000X
NH17036207Q00000X
VT032.0133795207QA0401X, 207Q00000X
RILP02581390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program