Individual
DR. STEPHEN S KORNBLUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
275 ROUTE 30 N, BOMOSEEN, VT 05732-9647
(802) 468-5641
(802) 468-2923
Mailing address
71 ALLEN STREET, SUITE 403, RUTLAND, VT 05701-4570
(802) 772-4414
(802) 772-7973
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0420011399
VT
207Q00000X
Family Medicine Physician
153606
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00773271
—
NY
05
—
1013905
—
VT
01
—
P00479978
RR MEDICARE
VT
Enumeration date
05/15/2006
Last updated
09/02/2016
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