Provider Demographics
NPI:1699965509
Name:SPITELLIE, PETE HUNTER (MD)
Entity type:Individual
Prefix:DR
First Name:PETE
Middle Name:HUNTER
Last Name:SPITELLIE
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 1:1 SEBRING RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7836
Mailing Address - Country:US
Mailing Address - Phone:541-326-8457
Mailing Address - Fax:
Practice Address - Street 1:1 SEBRING RD
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7836
Practice Address - Country:US
Practice Address - Phone:541-326-8457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD27674207W00000X
VT042.0013083207W00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274488Medicaid
OR274488Medicaid