Provider Demographics
NPI:1861162299
Name:KELLOGG, CARLTON L (PA-C)
Entity type:Individual
Prefix:
First Name:CARLTON
Middle Name:L
Last Name:KELLOGG
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2041 RUSSELLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05738-9444
Mailing Address - Country:US
Mailing Address - Phone:802-779-6744
Mailing Address - Fax:
Practice Address - Street 1:1 COMMONS ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4652
Practice Address - Country:US
Practice Address - Phone:802-747-1857
Practice Address - Fax:802-747-0129
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
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Provider Licenses
StateLicense IDTaxonomies
VT055.0031529363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant