Basic Information
Provider Information
NPI: 1851341671
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GUNTHER
FirstName: PETER
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 617 RIVERSIDE AVE
Address2:  
City: BURLINGTON
State: VT
PostalCode: 054011601
CountryCode: US
TelephoneNumber: 8025408557
FaxNumber: 8028604313
Practice Location
Address1: 368 DORSET ST
Address2: SUITE 1
City: SOUTH BURLINGTON
State: VT
PostalCode: 054036212
CountryCode: US
TelephoneNumber: 8028601441
FaxNumber: 8028604646
Other Information
ProviderEnumerationDate: 05/11/2006
LastUpdateDate: 09/13/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X42-0007238VTY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
000250205VT MEDICAID
11021814801VTRAIL ROAD MEDICAREOTHER


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