Provider Demographics
NPI:1174519698
Name:SOBEL, EITAN (MD)
Entity type:Individual
Prefix:DR
First Name:EITAN
Middle Name:
Last Name:SOBEL
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 1:160 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:160 ALLEN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4560
Practice Address - Country:US
Practice Address - Phone:802-775-7111
Practice Address - Fax:573-302-2241
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005018610208M00000X
VT042-0011633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1015594Medicaid
NY01507533Medicaid
MOP00271468OtherRAILROAD MEDICARE
MO207478603Medicaid
VTY400182656Medicare PIN
MO936053557Medicare PIN
G001819Medicare UPIN