Active NPI
David Indenbaum, MD
- Emergency Medicine Physician
- Berlin, VT
National Provider Identifier
1013936830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 042-0006709
- Practice address
- 130 Fisher Rd
Berlin, VT 05602-9516 - Phone
- (802) 371-4263
- Fax
- (802) 371-4481
- NPI assigned
- Jul 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 042-0006709 | VT | Primary |
Addresses
Primary practice location
130 Fisher Rd
Berlin, VT 05602-9516
Mailing address
PO Box 547
Att: CVMC Finance Dept
Barre, VT 05641-0547
Phone (802) 371-4263
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0005450 | Medicaid | VT | |
| PX6329 | Other | VT | MEDICARE PTAN LINKED TO CVMC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042-0006709 | VT | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1396396800000",
"number": "1013936830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 547",
"address_2": "ATT: CVMC FINANCE DEPT",
"city": "BARRE",
"state": "VT",
"postal_code": "056410547",
"telephone_number": "802-371-4263",
"fax_number": "802-371-4481"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 FISHER RD",
"city": "BERLIN",
"state": "VT",
"postal_code": "056029516",
"telephone_number": "802-371-4263",
"fax_number": "802-371-4481"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INDENBAUM",
"first_name": "DAVID",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-19",
"last_updated": "2014-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "VT",
"license": "042-0006709",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0005450",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN LINKED TO CVMC",
"identifier": "PX6329",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Berlin, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.