Michael Andrew Lamantia, M.D.
Individual provider Active NPI Geriatric Medicine (Internal Medicine) Physician · Colchester, VT
NPI 1801005632 · NPPES record last updated Jun 9, 2016
Key facts
- NPI
- 1801005632
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Geriatric Medicine (Internal Medicine) Physician 207RG0300X
- License
- 042.0013352 (VT)
- Practice address
- 792 College Pkwy
Uvm Medical Center - Div. of Internal Med. & Geriatrics
Colchester, VT 05446-3052 - Phone
- (802) 847-1111
- Fax
- (802) 847-7594
- NPI assigned
- May 21, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160602000372 | VT | Practitioner - Geriatric Medicine | 4587717137 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01069340A | IN | MD | Geriatric Medicine (Internal Medicine) Physician |
| 2008-00511 | NC | MD | Geriatric Medicine (Internal Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Vermont Medical Center Inc | Current |
Accepting new patients | |
| University Medical Diagnostic Associates, Inc. | Past | Accepting new patients |
Locations
111 Colchester Ave
Burlington, VT 05401
Phone (802) 656-2415
1 S Prospect St
Burlington, VT 05401
Phone (802) 847-4531
792 College Pkwy
Colchester, VT 05446
Phone (802) 847-0193
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | 2008-00511 | NC | |
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | 01069340A | IN | |
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | 042.0013352 | VT | Yes |
Addresses
Primary practice location
792 College Pkwy
Uvm Medical Center - Div. of Internal Med. & Geriatrics
Colchester, VT 05446-3052
Mailing address
792 College Pkwy
Uvm Medical Center - Div. of Internal Med. & Geriatrics
Colchester, VT 05446-3052
Phone (802) 847-1111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201025030 | Medicaid | IN |
Other providers in Colchester, VT
- Lisa Ann Koval
- Thomas Kristiansen
- Tomoko Kunita
- Jennifer I L'Ecuyer
- Lake Superior Nurse Anesthesia
- Nicholas Randle Lamothe
- Tori Duchesneau Lamphere
- Tracy G. Lamphere
- Alan Landau
- Leslie L Langevin
All providers in Colchester, VT · Geriatric Medicine (Internal Medicine) 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 Jun 9, 2016. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.