1801895818 NPI number — DR. NANCY SCATTERGOOD DONAVAN M.D.

Table of content: DR. NANCY SCATTERGOOD DONAVAN M.D. (NPI 1801895818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801895818 NPI number — DR. NANCY SCATTERGOOD DONAVAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONAVAN
Provider First Name:
NANCY
Provider Middle Name:
SCATTERGOOD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCATTERGOOD
Provider Other First Name:
NANCY
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1801895818
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2015
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:
802-681-8528
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:
802-681-8528
Provider Business Practice Location Address Fax Number:
802-442-6703
Provider Enumeration Date:
07/20/2005

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: 207Q00000X , with the licence number:  0420006890 , 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: 00028237 . This is a "BLUE CROSS/BLUE SHIELD" 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: 4482963 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0005554 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08198 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10002929 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8000200 . This is a "LADIES FIRST" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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