Individual
DR. THEODORE R WISSINK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
118 TILLEY DR STE 201, SOUTH BURLINGTON, VT 05403-4450
(802) 847-5550
(802) 847-3646
Mailing address
111 COLCHESTER AVE, BURLINGTON, VT 05401-1473
(802) 847-0000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
017817
ME
207Q00000X
Family Medicine Physician
Primary
042.0019084
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30207877
—
NH
05
—
432952299
—
ME
Enumeration date
11/21/2006
Last updated
12/22/2025
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