Provider Demographics
NPI:1063405876
Name:MEASECK, DEAN D (PA)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:D
Last Name:MEASECK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 DEWEY ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2225
Mailing Address - Country:US
Mailing Address - Phone:802-442-6314
Mailing Address - Fax:802-447-1686
Practice Address - Street 1:332 DEWEY ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2225
Practice Address - Country:US
Practice Address - Phone:802-442-6314
Practice Address - Fax:802-447-1686
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0550030248363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT932666OtherMVP
VTORTH19364OtherBCBS
VT0002380Medicaid
VT932666OtherMVP