Basic Information
| Provider Information | |||||||||
| NPI: | 1992769863 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRIMEAU | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 165 SHERMAN DR | ||||||||
| Address2: | |||||||||
| City: | ST JOHNSBURY | ||||||||
| State: | VT | ||||||||
| PostalCode: | 058199811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027489405 | ||||||||
| FaxNumber: | 8027484540 | ||||||||
| Practice Location | |||||||||
| Address1: | 82 MAPLE | ||||||||
| Address2: | |||||||||
| City: | ISLAND POND | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027234300 | ||||||||
| FaxNumber: | 8027234544 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 07/20/2010 | ||||||||
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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 | 0420008428 | VT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 0420008428 | VT | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 0VN0224 | 05 | VT | MEDICAID | E93123 | 01 | VT | MEDICARE UPIN NUMBER | OTHER |