NPIMap

Individual provider Active NPI

Mark Edgar Lach, MD

  • Diagnostic Radiology Physician
  • Burlington, VT
National Provider Identifier
1063421295
Registry record updated Aug 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
042-0011386 Issued in VT
Practice address
111 Colchester Ave
Fletcher Allen Health Care
Burlington, VT 05401-1473
Phone
(802) 847-5647
NPI assigned
Aug 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2008

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X M-8607 ID
Diagnostic Radiology Physician 2085R0202X 43235-020 WI
Diagnostic Radiology Physician 2085R0202X 19027 OK
Diagnostic Radiology Physician 2085R0202X K1519 TX
Diagnostic Radiology Physician 2085R0202X 042-0011386 VT Primary

Addresses

Primary practice location

111 Colchester Ave
Fletcher Allen Health Care
Burlington, VT 05401-1473

Mailing address

111 Colchester Ave
Fletcher Allen Health Care
Burlington, VT 05401-1473
Phone (802) 847-5647

Other identifiers 1

IdentifierTypeStateIssuer
806357400MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081021000386 VT Practitioner - Diagnostic Radiology 5193754307 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Porter Hospital IncGroup PAC ID 1850365180, shared by 5 NPIs, 116 clinicians

Practice addresses (Care Compare)

1 S Prospect St
Burlington, VT 05401-3456
Phone (802) 847-0000

111 Colchester Ave
Burlington, VT 05401-1473
Phone (802) 847-0000

115 Porter Dr
Middlebury, VT 05753-8423
Phone (802) 388-4701

192 Tilley Dr
Orthopeadic
S Burlington, VT 05403-4440
Phone (802) 847-4690

790 College Pkwy
Colchester, VT 05446-3007
Phone (802) 847-0000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M-8607IDMDDiagnostic Radiology Physician
19027OKMDDiagnostic Radiology Physician
K1519TXMDDiagnostic Radiology Physician
042-0011386VTMDDiagnostic Radiology Physician
43235-020WIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Porter Hospital, Inc CurrentSince Mar 28, 2024 Accepting new patients
Central Vermont Medical Center Inc CurrentSince Mar 28, 2024 Accepting new patients
Porter Hospital Inc Current Accepting new patients
Boise Advanced Imaging PLLC Diagnostic Radiology Past Accepting new patients
Advanced Imaging at Community Medical Center, LLC Past Accepting new patients
Gem State Radiology LLP Diagnostic Radiology Past Accepting new patients
Northeast Texas Radiology Consultants Diagnostic Radiology Past Accepting new patients
Missoula Radiology PC Diagnostic Radiology PastSince Jun 5, 2012 Accepting new patients

Locations

130 Fisher Rd
Berlin, VT 05602
Phone (802) 225-5820

130 Fisher Rd
#C
Berlin, VT 05602
Phone (802) 225-5400

111 Colchester Ave
Burlington, VT 05401
Phone (802) 656-2415

104 Porter Dr
Middlebury, VT 05753
Phone (802) 388-5682

82 Catamount Park
Middlebury, VT 05753
Phone (802) 388-7185

115 Porter Dr
Middlebury, VT 05753
Phone (802) 388-4701

Interoperability endpoints

  • Direct secure messaging: mlach10772@direct.uvmhealth.org

Organizations & group practices 9

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.

Hospital & facility affiliations 21

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219104000000",
    "number": "1063421295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 COLCHESTER AVE",
            "address_2": "FLETCHER ALLEN HEALTH CARE",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054011473",
            "telephone_number": "802-847-5647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 COLCHESTER AVE",
            "address_2": "FLETCHER ALLEN HEALTH CARE",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054011473",
            "telephone_number": "802-847-5647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACH",
        "first_name": "MARK",
        "middle_name": "EDGAR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2008-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "ID",
            "license": "M-8607",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "43235-020",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OK",
            "license": "19027",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "K1519",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VT",
            "license": "042-0011386",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806357400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, VT

Sources for this page

Verify at the official NPI Registry.