Provider Demographics
NPI:1386663094
Name:MACDONALD, GREGORY J (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:CENTRAL VERMONT MEDICAL CENTER-FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-225-5660
Mailing Address - Fax:802-229-9533
Practice Address - Street 1:130 FISHER RD
Practice Address - Street 2:MOB- A SUITE 2-1
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9516
Practice Address - Country:US
Practice Address - Phone:802-225-5660
Practice Address - Fax:802-229-2533
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0006170207RC0000X
VT420006170207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0004794Medicaid
VT060014974OtherRAIL ROAD MEDICARE
VTP01125401OtherRAILROAD MEDICARE LINKED TO CVMC MGP
VTD03286Medicare UPIN
VTVT479402Medicare PIN
VTVT4794Medicare PIN