Provider Demographics
NPI:1699815365
Name:VANTUINEN, CRAIG R (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:R
Last Name:VANTUINEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 WINOOSKI STREET
Mailing Address - Street 2:PO BOX 78
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-0078
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2225 PORTLAND STREET
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819
Practice Address - Country:US
Practice Address - Phone:802-748-3181
Practice Address - Fax:802-748-0704
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-00078442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN0268Medicaid
VT0VN0268Medicaid
VTVN0268Medicare ID - Type Unspecified