1538221502 NPI number — NANCY SCATTERGOOD DONAVAN MD

Table of content: (NPI 1538221502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538221502 NPI number — NANCY SCATTERGOOD DONAVAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NANCY SCATTERGOOD DONAVAN MD
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:
6
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:
1538221502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2074 S STREAM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENNINGTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05201-8886
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-379-5874
Provider Business Mailing Address Fax Number:
802-442-6703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2074 S STREAM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENNINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05201-8886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-379-5874
Provider Business Practice Location Address Fax Number:
802-442-6703
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCATTERGOOD
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
802-379-5874

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0420006890 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 0420010148 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 1010021887 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00049901 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 0NP2167 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0VN2535 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0005554 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080172102 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 080066554 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 00028237 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 08328 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 319096 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 08198 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 10053531 . This is a "CDPHP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 00029207 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 10002929 . This is a "CDPHP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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