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Individual

KERRY N FANTELLI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.

Contact information

Practice address
617 RIVERSIDE AVE, BURLINGTON, VT 05401-1601
(802) 864-6309
(802) 860-4324
Mailing address
74 OAKWOOD DR, SOUTH BURLINGTON, VT 05403-6224
(802) 863-7913

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0550030723
VT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4141802
MVP
VT
01
58727
BLUE CROSS BLUE SHIELD
VT
05
9000147
VT
Enumeration date
05/31/2006
Last updated
07/08/2007
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