Provider Demographics
NPI:1366528259
Name:CHAMPLAIN VALLEY FOOT & ANKLE, P.C.
Entity type:Organization
Organization Name:CHAMPLAIN VALLEY FOOT & ANKLE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MERENA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:802-879-7992
Mailing Address - Street 1:55 MAIN ST
Mailing Address - Street 2:STE 1
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3191
Mailing Address - Country:US
Mailing Address - Phone:802-879-7992
Mailing Address - Fax:802-879-6969
Practice Address - Street 1:55 MAIN ST
Practice Address - Street 2:STE 1
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3191
Practice Address - Country:US
Practice Address - Phone:802-879-7992
Practice Address - Fax:802-879-6969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT056-0000174213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT5468501OtherFLETCHER ALLEN PREFERRED
VTCHAM00068673OtherBC/BS
VT0VN3709Medicaid
VT788692OtherMVP
VT5468501OtherFLETCHER ALLEN PREFERRED