Basic Information
| Provider Information | |||||||||
| NPI: | 1174519698 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOBEL | ||||||||
| FirstName: | EITAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 ALLEN ST | ||||||||
| Address2: | |||||||||
| City: | RUTLAND | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057014560 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 160 ALLEN ST | ||||||||
| Address2: | |||||||||
| City: | RUTLAND | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057014560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027757111 | ||||||||
| FaxNumber: | 5733022241 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 08/26/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 2005018610 | MO | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 042-0011633 | VT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1015594 | 05 | VT | MEDICAID | 01507533 | 05 | NY | MEDICAID | P00271468 | 01 | MO | RAILROAD MEDICARE | OTHER | 207478603 | 05 | MO | MEDICAID |