1447257555 NPI number — VERMONT CENTER FOR CANCER MEDICINE, INC.

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 1447257555 NPI number — VERMONT CENTER FOR CANCER MEDICINE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERMONT CENTER FOR CANCER MEDICINE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447257555
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
792 COLLEGE PKWY
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
COLCHESTER
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05446-3052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-655-3400
Provider Business Mailing Address Fax Number:
802-655-9170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
792 COLLEGE PKWY
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
COLCHESTER
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05446-3052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-655-3400
Provider Business Practice Location Address Fax Number:
802-655-9170
Provider Enumeration Date:
07/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PASCHALL
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
802-655-7173

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , 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: OVN1029 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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