1942328737 NPI number — WILLIAM A DEVOE LADC

Table of content: WILLIAM A DEVOE LADC (NPI 1942328737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942328737 NPI number — WILLIAM A DEVOE LADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEVOE
Provider First Name:
WILLIAM
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LADC
Provider Gender Code:
M

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:
1942328737
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
390 RIVER ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-886-4500
Provider Business Mailing Address Fax Number:
802-886-4520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 ELM ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRATTLEBORO
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-254-7511
Provider Business Practice Location Address Fax Number:
802-254-7506
Provider Enumeration Date:
03/27/2007

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: 101YA0400X , with the licence number:  000315 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103T00000X , with the licence number: 000315 , 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: 28666 . This is a "BLUE CROSS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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