Individual provider Active NPI

Luiz Mauricio Kolankiewicz, M.D.

  • Nephrology Physician
  • White River Junction, VT
National Provider Identifier
1043529506
Registry record updated Jul 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
262974 Issued in NY
Practice address
215 N Main St
White River Junction, VT 05009-1538
Phone
(802) 295-9363
NPI assigned
Oct 1, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 262974 NY Primary
Nephrology Physician 207RN0300X 23096 NH
Nephrology Physician 207RN0300X 0101248493 VA
Nephrology Physician 207RN0300X MD13489 RI

Addresses

Primary practice location

215 N Main St
White River Junction, VT 05009-1538

Mailing address

69 Etna Rd Unit 118
Lebanon, NH 03766-2404
Phone (201) 240-7762

Other practice location 1

1287 N Main St Unit X
Providence, RI 02904-1856
Phone (401) 272-2724

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

LicenseStateTypeSpecialty
23096NHMDNephrology Physician
262974NYMDNephrology Physician
MD13489RIMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Peninsula Kidney Associates PC Nephrology PastSince Jan 1, 2003 Accepting new patients
Peninsula Vascular Center, P.C. Nephrology Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784592000000",
    "number": "1043529506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 ETNA RD UNIT 118",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037662404",
            "telephone_number": "201-240-7762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 N MAIN ST",
            "city": "WHITE RIVER JUNCTION",
            "state": "VT",
            "postal_code": "050091538",
            "telephone_number": "802-295-9363"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1287 N Main St Unit X",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029041856",
            "country_code": "US",
            "telephone_number": "401-272-2724",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOLANKIEWICZ",
        "first_name": "LUIZ",
        "middle_name": "MAURICIO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-01",
        "last_updated": "2026-07-21",
        "certification_date": "2026-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "262974",
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NH",
            "license": "23096",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "VA",
            "license": "0101248493",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "RI",
            "license": "MD13489",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in White River Junction, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.