Individual
ELISABETH KIRSTEN WEGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
111 COLCHESTER AVE, FAHC, ACC MP4, BURLINGTON, VT 05401-1473
(802) 847-1400
Mailing address
111 COLCHESTER AVE, BURLINGTON, VT 05401-1473
(802) 847-1400
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
042-0009221
VT
207VG0400X
Gynecology Physician
042-0009221
VT
207VX0000X
Obstetrics Physician
042-0009221
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01647667
NY MEDICAID
NY
05
—
0VN1330
—
VT
Enumeration date
07/18/2006
Last updated
10/04/2013
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