LAKE CHAMPLAIN GYNECOLOGIC ONCOLOGY, PC
NPI 1164418455
Obstetrics & Gynecology - Gynecologic Oncology in South Burlington, VT
- Organization
- Obstetrics & Gynecology
- Gynecologic Oncology
- CLIA Number: 33D1024765
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 04-20-2026
About LAKE CHAMPLAIN GYNECOLOGIC ONCOLOGY, PC
This page provides the complete NPI Profile along with additional information for Lake Champlain Gynecologic Oncology, Pc, a women's health care provider established in South Burlington, Vermont operating as a Obstetrics & Gynecology, focusing in gynecologic oncology . The healthcare provider is registered in the NPI registry with number 1164418455 assigned on September 2005. The practitioner's primary taxonomy code is 207VX0201X. The provider is registered as an organization and their NPI record was last updated 13 years ago. Lake Champlain Gynecologic Oncology, Pc operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The authorized official of this NPI record is Dr. Gamal H Eltabbakh M.d. (President)
- NPI
- 1164418455 Verify this NPI
- Provider Name
- LAKE CHAMPLAIN GYNECOLOGIC ONCOLOGY, PC
- Entity Type
- Organization
- Location Address
- 1060 HINESBURG RD SUITE 301 SOUTH BURLINGTON, VT 05403
- Location Phone
- (802) 859-9500
- Location Fax
- (802) 859-9944
- Mailing Address
- 1060 HINESBURG RD SUITE 301 SOUTH BURLINGTON, VT 05403
- Mailing Phone
- (802) 859-9500
- Mailing Fax
- (802) 859-9944
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 09-22-2005
- Last Update Date
- 05-23-2013
- Code Navigator
Women's health care providers like Lake Champlain Gynecologic Oncology, Pc treat and diagnose diseases and conditions that affect a woman's physical and emotional health. Women's health professionals come from a variety of different specialties, including obstetrician/gynecologists, general surgeons, perinatologists, physician assistants, nurse practitioners or nurse midwives. A women's health provider might help you with family planning, breast care, pregnancy and child birth, osteoporosis, menopause, heart disease, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Obstetrics & Gynecology Gynecologic Oncology
- Taxonomy Code
- 207VX0201X
- Type
- Allopathic & Osteopathic Physicians
- Taxonomy Description
- An obstetrician/gynecologist who provides consultation and comprehensive management of patients with gynecologic cancer, including those diagnostic and therapeutic procedures necessary for the total care of the patient with gynecologic cancer and resulting complications.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | |
| 2 | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| AA1688 | MEDICARE PIN (08) | NY | |
| 1008935 | MEDICAID (05) | VT | |
| 01760585 | MEDICAID (05) | NY | |
| VN2936 | MEDICARE PIN (08) | VT |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 33D1024765
- Facility Type
- Physician Office
- Certificate Effective Date
- April 21, 2024
- Certificate Expiration Date
- April 20, 2026
- Laboratory Director
- DR. GAMAL H. ELTABBAKH
- Certificate Type
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate Type Description
- This CLIA certificate is issued to Lake Champlain Gynecologic Oncology, Pc in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.
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Other Providers at the Same Location
The following 6 providers are registered at the same or a nearby location.
SOUTH BURLINGTON, VT 05403
SOUTH BURLINGTON, VT 05403
SOUTH BURLINGTON, VT 05403
SOUTH BURLINGTON, VT 05403
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1164418455, enumerated as an "organization" on September 22, 2005.
The provider is located at 1060 HINESBURG RD SUITE 301 SOUTH BURLINGTON, VT 05403 and the phone number is (802) 859-9500.
Obstetrics & Gynecology with taxonomy code 207VX0201X and a focus in Gynecologic Oncology.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
