Provider Demographics
NPI:1144247834
Name:VITALETTI-COUGHLIN, ANNE (MD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:VITALETTI-COUGHLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 UPPER HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:STOWE
Mailing Address - State:VT
Mailing Address - Zip Code:05672-4520
Mailing Address - Country:US
Mailing Address - Phone:802-253-8735
Mailing Address - Fax:
Practice Address - Street 1:530 WASHINGTON HWY
Practice Address - Street 2:POB SUITE 1
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8715
Practice Address - Country:US
Practice Address - Phone:802-888-8392
Practice Address - Fax:802-888-5536
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420008983207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN1058OtherCIGNA
VT05V043OtherMVP
VTOVN1058Medicaid
VT19873OtherBLUE CROSS
VTOVN1058OtherCIGNA
VT19873OtherBLUE CROSS