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Contact Information

GEORGIA D ELTABBAKH, PA
1060 HINESBURG RD
SUITE 301
SOUTH BURLINGTON, VT05403-7612
 Phone: 802-859-9500
 Fax: 802-859-9944
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Medical

363AM0700X 97 Physician Assistant
 

Physician Assistant

363A00000X 97 Physician Assistant
 

Surgical

363AS0400X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for GEORGIA D ELTABBAKH · (Female)

NPI Number 1871589150
Status Active
Credentials PA (Physician Assistant)
Entity Individual
Enumeration date 09/22/2005
Last updated 06/28/2013 - About 13 years ago
Sole proprietor 1 No
Identifiers
  • NY License # 010999
  • VT License # 0550030657
  • VT Medicaid 90000398
Hospital affiliation(s)
  • CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CTR - (Acute Care)
    75 BEEKMAN STREET
    PLATTSBURGH, NY 12901
  • FLETCHER ALLEN HOSPITAL OF VERMONT - (Acute Care)
    111 COLCHESTER AVE
    BURLINGTON, VT 05401
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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