Individual
JOHN ERIC KOELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1315 HOSPITAL DR, NORTHEASTERN VT REGIONAL HOSPITAL, ST JOHNSBURY, VT 05819-9210
(802) 748-8141
(802) 748-4098
Mailing address
PO BOX 905, NORTHEASTERN VT REGIONAL HOSPITAL, ST JOHNSBURY, VT 05819-0905
(802) 748-8141
(802) 748-4098
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
042-0013372
VT
207Q00000X
Family Medicine Physician
200876
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000042317
GHI
NY
01
—
000401661005
BLUE SHIELD
NY
05
—
01592667
—
NY
01
—
040426007236
FIDELIS
NY
01
—
10020809
CDPHP
NY
01
—
43790
GHI HMO
NY
01
—
5968600
AETNA
NY
01
—
958301
MVP
NY
01
—
9X3071
EMPIRE BLUE CROSS
NY
Enumeration date
02/23/2006
Last updated
02/25/2016
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