Active NPI
Lucy J. Wollaeger, M.D.
- Emergency Medicine Physician
- Randolph, VT
National Provider Identifier
1750497111
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 0420007559
- Practice address
- 44 S Main St
Randolph, VT 05060-1381 - Phone
- (802) 728-7000
- Fax
- (802) 728-2394
- NPI assigned
- Aug 21, 2006
- Last updated
- Jul 9, 2007
- Sex
- Female
- 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 | 0420007559 | VT | Primary |
Addresses
Primary practice location
44 S Main St
Randolph, VT 05060-1381
Mailing address
PO Box 2000
Randolph, VT 05060-2000
Phone (802) 728-7000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0009193 | Medicaid | VT |
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 |
|---|---|---|---|
| 0420007559 | VT | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1750497111",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2000",
"city": "RANDOLPH",
"state": "VT",
"postal_code": "050602000",
"telephone_number": "802-728-7000",
"fax_number": "802-728-2394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "44 S MAIN ST",
"city": "RANDOLPH",
"state": "VT",
"postal_code": "050601381",
"telephone_number": "802-728-7000",
"fax_number": "802-728-2394"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLLAEGER",
"first_name": "LUCY",
"middle_name": "J.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-21",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "VT",
"license": "0420007559",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0009193",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Randolph, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.