Organization
LAKE CHAMPLAIN GYNECOLOGIC ONCOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GAMAL H ELTABBAKH M.D. (PRESIDENT)
(802) 859-9500
Entity
Organization
Contact information
Practice address
1060 HINESBURG RD, SUITE 301, SOUTH BURLINGTON, VT 05403-7612
(802) 859-9500
(802) 859-9944
Mailing address
1060 HINESBURG RD, SUITE 301, SOUTH BURLINGTON, VT 05403-7612
(802) 859-9500
(802) 859-9944
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01760585
—
NY
05
—
1008935
—
VT
Enumeration date
09/22/2005
Last updated
05/23/2013
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