Four Seasons Dermatology LLC
Organization Active NPI Dermatology Physician · Colchester, VT
NPI 1790737393 · NPPES record last updated Apr 28, 2022
Key facts
- NPI
- 1790737393
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- FOUR SEASONS DERMATOLOGY LLC
- Practice address
- 354 Mountain View Drive
Suite 300
Colchester, VT 05446-5988 - Phone
- (802) 864-0192
- Fax
- (802) 860-4919
- NPI assigned
- May 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Steven Robert Partilo, MD
- Title
- Member
- Phone
- (802) 864-0192
Practitioners 25
-
Todd Edgar Holmes, M.D.
-
Donald R. Laub Jr., M.D.
-
Laura McGevna, M.D.
-
Nicholas Brenny, PA-C
-
David Stephen Gawlik, PA-C, MS
-
Olivia Nemier, PA-C
-
Steven R Partilo, M.D.
-
Phoebe Pelkey, P.A.-C
-
Katelyn Shea, MD
-
Alicyn Trask, P.A.
-
Leah Teresa Villemaire, P.A.-C
-
Ashley Marie Zwickl, PA-C
-
Casey J Barcomb, PA-C
-
Mary Elizabeth Hughes, PA-C
-
Anna Jeannine Nichols, MD, PHD
-
Brooke Bessette Palmer, PA-C
-
Mark McKinley Ash, M.D.
-
Wasim Haidari, MD
-
Thomas Brett Davis, P.A.-C
-
Courtney A.E. Rauer, APRN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 33D2170852 | Four Seasons Dermatology LLC | Provider-performed microscopy | Aug 20, 2027 |
| 47D2218980 | Four Seasons Dermatology | Provider-performed microscopy | Mar 31, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040824001173 | VT | Part B Supplier - Clinic/Group Practice | 8820062946 |
Receives reassigned benefits from 20 practitioners Practice locations: Colchester, VT; Middlebury, VT; Shelburne, VT; Waterbury, VT |
National Provider Directory
Locations
2 Healey Ave
Plattsburgh, NY 12901
Phone (518) 561-2225
654 Granger Rd
Barre, VT 05641
Phone (802) 234-1384
110 Porter Dr
Middlebury, VT 05753
Phone (802) 382-3443
366 Dorset St
Ste 2
South Burlington, VT 05403
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | |||
| Dermatology Physician |
207N00000X | Yes | ||
| Orthopaedic Hand Surgery Physician |
207XS0106X | |||
| Plastic Surgery Physician |
208200000X |
Addresses
Primary practice location
354 Mountain View Drive
Suite 300
Colchester, VT 05446-5988
Mailing address
354 Mountain View Drive
Suite 300
Colchester, VT 05446-5988
Phone (802) 864-0192
Other practice location 1
110 Porter Dr
Middlebury, VT 05753-8527
Phone (802) 864-0192
Other practice location 2
28 Stowe St Ste 3
Waterbury, VT 05676-1883
Phone (802) 864-0192
Other practice location 3
2 Healey Ave
Plattsburgh, NY 12901-2413
Phone (802) 864-0192
Other providers in Colchester, VT
- Fletcher Allen Health Care,Inc
- Fletcher Allen Healthcare
- Jared Egerton Florance
- Karin Ford
- Danielle M Fougere
- Amy M Fox
- Keith Franchetti
- Candace L Fraser
- James Edward Freeman IV
- Danielle Joy Frey
All providers in Colchester, VT · Dermatology Physician in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.