Provider Demographics
NPI:1366524795
Name:SHAFTSBURY MEDICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:SHAFTSBURY MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-442-8531
Mailing Address - Street 1:PO BOX 379
Mailing Address - Street 2:
Mailing Address - City:SHAFTSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05262-0379
Mailing Address - Country:US
Mailing Address - Phone:802-442-8531
Mailing Address - Fax:802-442-1503
Practice Address - Street 1:677 VT. RTE. 7A
Practice Address - Street 2:
Practice Address - City:SHAFTSBURY
Practice Address - State:VT
Practice Address - Zip Code:05262-0379
Practice Address - Country:US
Practice Address - Phone:802-442-8531
Practice Address - Fax:802-442-1503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVT4495Medicaid
VT5141OtherMVP
VTSHAF00018096OtherVT BC-BS
VTVT4495Medicaid