Lake Champlain Gynecologic Oncology, PC

Primary specialty

Gynecologic Oncology PhysicianTaxonomy code 207VX0201X

Legal business name

LAKE CHAMPLAIN GYNECOLOGIC ONCOLOGY, PC

Practice address

1060 Hinesburg Rd
Suite 301
South Burlington, VT 05403-7612

Phone

(802) 859-9500

Fax

(802) 859-9944

NPI assigned

Sep 22, 2005

Last updated

May 23, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Gamal H Eltabbakh, M.D.NPI 1467448787

Title

President

Phone

(802) 859-9500

Specialties & licenses 3

Addresses

Other identifiers 2

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gamal H Eltabbakh, M.D.

  • Gynecologic Oncology Physician
  • South Burlington, VT
  • NPI 1467448787
  Authorized official Same address or phone
• Candis Joan Cousins, PAC

  • Physician Assistant
  • South Burlington, VT
  • NPI 1831207166
  NPD (past)
• Penelope M Gibson, PA

  • Medical Physician Assistant
  • Burlington, VT
  • NPI 1821166679
  NPD (past)
• Patricia Maria Spadanuda, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Burlington, VT
  • NPI 1457559601
  NPD (past)
• Leonard Tremblay, M.D.

  • Obstetrics & Gynecology Physician
  • Saint Albans, VT
  • NPI 1326003906
  NPD (past)

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369267200000",
    "number": "1164418455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1060 HINESBURG RD",
            "address_2": "SUITE 301",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054037612",
            "telephone_number": "802-859-9500",
            "fax_number": "802-859-9944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 HINESBURG RD",
            "address_2": "SUITE 301",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054037612",
            "telephone_number": "802-859-9500",
            "fax_number": "802-859-9944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CHAMPLAIN GYNECOLOGIC ONCOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-22",
        "last_updated": "2013-05-23",
        "status": "A",
        "authorized_official_last_name": "ELTABBAKH",
        "authorized_official_first_name": "GAMAL",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "802-859-9500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01760585",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1008935",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Lacey
• Sabrina Lacross
• James Lafferty
• Rony N Lahoud
• Bettina D Laidley, DMD
• Kate Lamancuso, MD
• Bruce Lancer
• Marshall L Land Jr., M.D.
• Kristen Lyons Landerman, M.S.
• Katherine A Lane, MD

• Gynecologic Oncology Physician in South Burlington, VT
• Providers in South Burlington, VT by specialty
• Gynecologic Oncology Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2013; 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.