Provider Demographics
NPI:1861415226
Name:SARTORELLI, KENNITH HANS (MD)
Entity type:Individual
Prefix:DR
First Name:KENNITH
Middle Name:HANS
Last Name:SARTORELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 COLCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1473
Mailing Address - Country:US
Mailing Address - Phone:802-847-4273
Mailing Address - Fax:802-847-8158
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:FLETCHER 4
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-4273
Practice Address - Fax:802-847-8158
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-00091442086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01568487Medicaid
VT0VN1178Medicaid
SAVN1178Medicare ID - Type Unspecified
NY01568487Medicaid