Basic Information
| Provider Information | |||||||||
| NPI: | 1770810848 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLEINER | ||||||||
| FirstName: | J ARTHUR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1153 | ||||||||
| Address2: | |||||||||
| City: | STOWE | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056721153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022491279 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1878 MOUNTAIN RD | ||||||||
| Address2: | |||||||||
| City: | STOWE | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056724776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022534853 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2009 | ||||||||
| LastUpdateDate: | 02/23/2015 | ||||||||
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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 | 207R00000X | 042-0009223 | VT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1017175 | 05 | VT | MEDICAID |