Provider Demographics
NPI:1588989016
Name:CONNOLLY, KRISTEN VAN WOERT (MD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:VAN WOERT
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:600 BLAIR PARK RD STE 285
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7586
Mailing Address - Country:US
Mailing Address - Phone:802-288-1140
Mailing Address - Fax:802-288-1144
Practice Address - Street 1:11 HAYDENBERRY DR STE 41
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468-3848
Practice Address - Country:US
Practice Address - Phone:802-893-1200
Practice Address - Fax:802-893-2756
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-27
Last Update Date:2023-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VT042.0012649208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1021912Medicaid