Provider Demographics
NPI:1992918486
Name:UNIVERSITY OF VERMONT
Entity type:Organization
Organization Name:UNIVERSITY OF VERMONT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:K
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-656-3350
Mailing Address - Street 1:UVM
Mailing Address - Street 2:PATRICK GYM
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05405-0117
Mailing Address - Country:US
Mailing Address - Phone:802-656-7750
Mailing Address - Fax:
Practice Address - Street 1:UVM
Practice Address - Street 2:PATRICK GYM
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05405-0117
Practice Address - Country:US
Practice Address - Phone:802-656-7750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health