Basic Information
| Provider Information | |||||||||
| NPI: | 1154349512 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAUB | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 COLCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054011473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028470000 | ||||||||
| FaxNumber: | 8028477083 | ||||||||
| Practice Location | |||||||||
| Address1: | 354 MOUNTAIN VIER DRIVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | COLCHESTER | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054465988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028640192 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 08/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 42-0008887 | VT | Y | Allopathic & Osteopathic Physicians | Plastic Surgery | 2082S0105X | 42-0008887 | VT | N | Allopathic & Osteopathic Physicians | Plastic Surgery | Surgery of the Hand |
ID Information
| ID | Type | State | Issuer | Description | E01753626 | 05 | NY | MEDICAID | OVN1072 | 05 | VT | MEDICAID |