Provider Demographics
NPI:1699761528
Name:BINNICK, ALAN NEAL (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:NEAL
Last Name:BINNICK
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 1:140 HOSPITAL DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-5010
Mailing Address - Country:US
Mailing Address - Phone:802-447-7441
Mailing Address - Fax:802-447-0254
Practice Address - Street 1:140 HOSPITAL DR
Practice Address - Street 2:SUITE 109
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-5010
Practice Address - Country:US
Practice Address - Phone:802-447-7441
Practice Address - Fax:802-447-0254
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420005614207ND0900X
MA43419207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1075267Medicaid
VTVT4919Medicare ID - Type Unspecified
VT1075267Medicaid