Kerry N Fantelli, P.A.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0550030723 Issued in VT

Practice address

617 Riverside Ave
Burlington, VT 05401-1601

Phone

(802) 864-6309

Fax

(802) 860-4324

NPI assigned

May 31, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Kerry Moruthane Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649227877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "74 OAKWOOD DR",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054036224",
            "telephone_number": "802-863-7913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 RIVERSIDE AVE",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054011601",
            "telephone_number": "802-864-6309",
            "fax_number": "802-860-4324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANTELLI",
        "first_name": "KERRY",
        "middle_name": "N",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VT",
            "license": "0550030723",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "4141802",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "58727",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000147",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VERMONT MANAGED CARE",
            "identifier": "58727",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KERRY",
            "last_name": "MORUTHANE",
            "credential": "P.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jonathan T Fairbank, MD
• Catherine T Falduto, APRN, FNP-C
• Nina Jane Falsen, LCMHC
• Michelle Ann Fane, LCMHC
• Loften Alexander Fansler, DO
• Borzoo Farhang, DO
• Lauren Elizabeth Faricy, M.D.
• Janet Foster Farina, R.PH.
• Joshua David Farkas, MD, MS
• Mollie Farnham-Stratton, MSW & MS

• Family Medicine Physician in Burlington, VT
• Providers in Burlington, VT by specialty
• Family Medicine Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.