1831170943 NPI number — DR. PETER MYLES WOOLHOUSE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831170943 NPI number — DR. PETER MYLES WOOLHOUSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOLHOUSE
Provider First Name:
PETER
Provider Middle Name:
MYLES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOOLHOUSE
Provider Other First Name:
PETER
Provider Other Middle Name:
MYLES
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1831170943
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
440 GREEN MOUNTAIN ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
514-932-5954
Provider Business Mailing Address Fax Number:
514-932-1565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
53 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHFORD
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05476-1151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-848-3829
Provider Business Practice Location Address Fax Number:
802-848-7554
Provider Enumeration Date:
11/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  016-0002132 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1008570 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com