DR. THEODORE G SHATTUCK (NPI# 1558361444) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558361444 |
| Entity Type | Individual |
| Full Name | DR. THEODORE G SHATTUCK |
| Credential | M.D. |
| Practice Address |
69 Allen St Suite 4 Rutland VT 05701-4564 |
| Mailing Address |
69 Allen St Suite 1 Rutland VT 05701-4564 |
| Practice Telephone | 8027753314 |
| Practice Fax Number | 8027759617 |
| Mailing Telephone | 8027753314 |
| Mailing Fax Number | 8027759617 |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngology | 042-0006143 | VT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VT | OOO9206 | 05 |
| Street Address |
69 ALLEN ST SUITE 4 |
| City | RUTLAND |
| State | VT |
| Zip Code | 05701-4564 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013913003 | Robert W Hartenstein | Audiologist | 69 Allen St, Ste 2, Rutland, VT 05701-4564 | 2005-06-23 |
| 1285108951 | Riley Ballard | Specialist/Technologist | 69 Allen St, Rutland, VT 05701-4564 | 2019-01-16 |
| 1902144405 | Peter C. Stickney, Md PC | Internal Medicine | 69 Allen St, Suite #5, Rutland, VT 05701-4590 | 2013-01-18 |
| 1831449412 | Glenn Anthony Gregory | Dentist | 69 Allen St, Suite 10, Rutland, VT 05701-4564 | 2012-09-11 |
| 1720397805 | Christopher Allen Nisbet | Optometrist | 69 Allen St, Suite 15, Rutland, VT 05701-4564 | 2010-10-06 |
| 1639301153 | Elizabeth H. Foley, M. D., PC | Dermatology | 69 Allen St, Suite #14, Rutland, VT 05701-4564 | 2009-08-17 |
| 1427283282 | Mid Vermont Healthcare | Nurse Practitioner | 69 Allen St, Suite 10, Rutland, VT 05701-4564 | 2009-05-22 |
| 1053511147 | Vermont Optical Corp | Eyewear Supplier (Equipment, not the service) | 69 Allen St, Suite 15, Rutland, VT 05701-4564 | 2007-07-18 |
| 1417151564 | Martin G Carmody | Podiatrist | 69 Allen St, Ste 8, Rutland, VT 05701-4564 | 2007-06-13 |
| 1609079763 | Center for Integrative Medicine | Specialist | 69 Allen St, Suite 9, Rutland, VT 05701-4564 | 2007-06-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639721186 | All Dimensions Primary Care Pllc | Physician Assistant | 92 Allen Street, Rutland, VT 05701 | 2019-07-15 |
| 1962809053 | Laura Kalinen Laprise | Nurse Practitioner | Rutland Community Health Center, 215 Stratton Road, Rutland, VT 05701 | 2014-12-04 |
| 1962818781 | Andrea Louise Welch | Pharmacist | 1 Rutland Shopping Plaza, Rutland, VT 05701 | 2014-07-02 |
| 1396158903 | Gwendolyn Koenig | Counselor | 78 South Main St., Rutland, VT 05701 | 2014-06-11 |
| 1194088195 | Marcie Bouchard | Early Intervention Provider Agency | 24a East Street, Rutland, VT 05701 | 2012-06-25 |
| 1790047009 | Pamela Lenoci | Massage Therapist | 196 Joshua Place, Rutland, VT 05701 | 2012-06-12 |
| 1528339959 | Deborah E. Boston | Social Worker | 128 Merchants Row Ste 510, Rutland, VT 05701 | 2012-01-17 |
| 1235431834 | Alicia Marie Riesterer | Occupational Therapy Assistant | 46 Nichols St., Rutland Healthcare and Rehabilitation Center, Rutland, VT 05701 | 2010-12-02 |
| 1497085401 | Lauren Ann Lasante | Counselor | 198 N Main St Ste C-5, Rutland, VT 05701 | 2010-01-14 |
| 1568692515 | Steven C. Duboff, Dmd, PC | Dentist | 198 North Main St, Rutland, VT 05701 | 2009-07-23 |
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| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871522748 | Michell Thurmond | Otolaryngology | 69 Allen St, Suite 1, Rutland, VT 05701-4564 | 2006-07-02 |
| 1336149160 | David R Charnock | Otolaryngology | 69 Allen St, Suite 4, Rutland, VT 05701-4564 | 2005-07-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174935381 | Erin Tracy Ostby | Otolaryngology | 111 Colchester Ave Fl 4, Burlington, VT 05401-1473 | 2014-05-21 |
| 1154552651 | Patrick Hervey Stine | Otolaryngology | 2195 S Bingham St, Whiting, VT 05778-9508 | 2009-07-31 |
| 1770662462 | Paul M Julien | Otolaryngology | 637 Union Street, Newport, VT 05855 | 2006-11-03 |
| 1265532444 | Robert Joseph Jauch | Otolaryngology | 714 Breezy Hill Road, Suite A, St Johnsbury, VT 05819 | 2006-09-25 |
| 1750301651 | Louise Davies | Otolaryngology | Va Outcomes Group - 111b, 215 North Main Street, White River Junction, VT 05009 | 2006-07-20 |
| 1124048459 | Porter Hospital Inc | Otolaryngology | 1330 Exchange Street Suite 202, Porter Ent, Middlebury, VT 05753 | 2006-07-20 |
| 1942259379 | Donald A Leopold | Otolaryngology | 111 Colchoster Ave - Ent Wp4, Burlington, VT 05401 | 2006-05-10 |
| 1316910714 | Springfield Hospital | Otolaryngology | 364 River St, Springfield, VT 05156 | 2006-02-08 |
| 1740287283 | Richard C Lyons | Otolaryngology | 389 E Allen St, Winooski, VT 05404-1560 | 2005-06-30 |
| 1821581174 | Northwestern Medical Center, Inc. | Otolaryngology | 10 Crest Rd, Saint Albans, VT 05478-9701 | 2018-06-12 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.