Provider Demographics
NPI:1730330762
Name:ROBERT J JAUCH, MD
Entity type:Organization
Organization Name:ROBERT J JAUCH, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-748-5126
Mailing Address - Street 1:714 BREEZY HILL RD
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-8882
Mailing Address - Country:US
Mailing Address - Phone:802-748-5126
Mailing Address - Fax:802-748-1107
Practice Address - Street 1:714 BREEZY HILL RD
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-8882
Practice Address - Country:US
Practice Address - Phone:802-748-5126
Practice Address - Fax:802-748-1107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT008425846237600000X
VT420006154207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVT7982OtherMEDICARE
VT04PO12OtherMVP
VT0925477OtherCIGNA
NH0100833Y0VT01OtherANTHEM NEW HAMPSHIRE BLUE SHIELD
NH99007982Medicaid
VT0007982Medicaid
VT1047982OtherVERMONT BLUE CROSS & BLUE SHIELD
VT0925477OtherCIGNA