Provider Demographics
NPI:1366580193
Name:ANNE VITALETTI-COUGHLIN
Entity type:Organization
Organization Name:ANNE VITALETTI-COUGHLIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:VITALETTI-COUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-888-8392
Mailing Address - Street 1:530 WASHINGTON HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-8715
Mailing Address - Country:US
Mailing Address - Phone:802-888-8392
Mailing Address - Fax:802-888-5536
Practice Address - Street 1:530 WASHINGTON HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8715
Practice Address - Country:US
Practice Address - Phone:802-888-8392
Practice Address - Fax:802-888-5536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420008983207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTINTE00059515OtherBC
VT1009822Medicaid
VTVN3259Medicare ID - Type Unspecified