| Dr Christina Ilse Dinicola, MD | |
|
40 S Main St, Randolph, VT 05060-1377 | |
| (802) 728-2420 | |
| (802) 728-2111 |
| Full Name | Dr Christina Ilse Dinicola |
|---|---|
| Gender | Female |
| Speciality | Pediatrics |
| Location | 40 S Main St, Randolph, Vermont |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962670455 | NPI | - | NPPES |
| 1024133070001 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | MD426793 (Pennsylvania) | Secondary |
| 208000000X | Pediatrics | 0420013072 (Vermont) | Primary |
| 208000000X | Pediatrics | 25MA08994900 (New Jersey) | Secondary |
| Entity Name | Gifford Medical Center Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1942329446 PECOS PAC ID: 4880683663 Enrollment ID: O20040507000460 |
| Entity Name | Gifford Health Care Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1013269430 PECOS PAC ID: 2668624982 Enrollment ID: O20121213000467 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Christina Ilse Dinicola, MD Po Box 2000, Randolph, VT 05060-2000 Ph: (802) 728-7000 | Dr Christina Ilse Dinicola, MD 40 S Main St, Randolph, VT 05060-1377 Ph: (802) 728-2420 |
Joseph C Pelletier, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 44 S Main St, Randolph, VT 05060 Phone: 802-728-2420 Fax: 802-728-2394 | |
Devin Alexander, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 44 S Main St, Randolph, VT 05060 Phone: 802-728-2420 | |
Louis A. Dinicola, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 44 S Main St, Randolph, VT 05060 Phone: 802-728-2420 Fax: 802-728-2613 | |
Elizabeth H. Jewett, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 44 S Main St, Randolph, VT 05060 Phone: 802-728-2420 Fax: 802-728-2613 | |
Rebecca Elizabeth Kincaid, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 40 S Main St, Randolph, VT 05060 Phone: 802-728-2420 Fax: 802-728-2111 |