Provider Demographics
NPI:1124551601
Name:PARKER, MICHAEL HARRISON (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HARRISON
Last Name:PARKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 COLCHESTER AVE
Mailing Address - Street 2:MAIN CAMPUS, MAIN PAVILION, LEVEL 5
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1473
Mailing Address - Country:US
Mailing Address - Phone:802-847-4548
Mailing Address - Fax:802-847-3581
Practice Address - Street 1:111 COLCHESTER AVENUE
Practice Address - Street 2:MAIN CAMPUS, MAIN PAVILION, LEVEL 5
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-4548
Practice Address - Fax:802-847-3581
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.159691208600000X
IL0361596912086S0129X
VT042.00177302086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery