LAKE CHAMPLAIN GYNECOLOGIC ONCOLOGY, PC – NPI #1164418455
Obstetrics & Gynecology

An obstetrician/gynecologist who provides consultation and comprehensive management of patients with gynecologic cancer, including those diagnostic and therapeutic procedures necessary for the total care of the patient with gynecologic cancer and resulting complications.

LAKE CHAMPLAIN GYNECOLOGIC ONCOLOGY, PC is a provider located in SOUTH BURLINGTON, VT. NPPES has assigned the NPI number 1164418455 to LAKE CHAMPLAIN GYNECOLOGIC ONCOLOGY, PC on September 22, 2005. It is a Type-2 NPI, indicating this NPI number is associated with an organization. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 207VX0201X from the Health Care Provider Taxonomy code set, which is classified as Obstetrics & Gynecology, specializing in Gynecologic Oncology

The NPI profile was previously updated about 13 years ago on May 23, 2013. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for LAKE CHAMPLAIN GYNECOLOGIC ONCOLOGY, PC below.

NPI Profile for
LAKE CHAMPLAIN GYNECOLOGIC ONCOLOGY, PC

NPI Number
1164418455
Enumeration Date

(more than 20 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
LAKE CHAMPLAIN GYNECOLOGIC ONCOLOGY, PC
Primary location
1060 HINESBURG RD
SUITE 301
SOUTH BURLINGTON, VT 05403-7612
Phone: (802) 859-9500 Fax: (802) 859-9944
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
GAMAL ELTABBAKH
PRESIDENT
Phone: (802) 859-9500
Updated
Identifiers

Identifiers for LAKE CHAMPLAIN GYNECOLOGIC ONCOLOGY, PC

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
MEDICAIDNY01760585
MEDICAIDVT1008935
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207VX0201X
- Obstetrics & Gynecology / Gynecologic Oncology (Primary)
363L00000X
- Nurse Practitioner
363A00000X
- Physician Assistant

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.