Provider Demographics
NPI:1992964050
Name:ALLERGY & ASTHMA SPECIALISTS OF NORTHERN VERMONT PC
Entity type:Organization
Organization Name:ALLERGY & ASTHMA SPECIALISTS OF NORTHERN VERMONT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-524-2550
Mailing Address - Street 1:55 MAIN ST
Mailing Address - Street 2:STE 2
Mailing Address - City:ESSEX JCT
Mailing Address - State:VT
Mailing Address - Zip Code:05452-6100
Mailing Address - Country:US
Mailing Address - Phone:802-879-1310
Mailing Address - Fax:802-879-1330
Practice Address - Street 1:55 MAIN ST
Practice Address - Street 2:STE 2
Practice Address - City:ESSEX JCT
Practice Address - State:VT
Practice Address - Zip Code:05452-6100
Practice Address - Country:US
Practice Address - Phone:802-879-1310
Practice Address - Fax:802-879-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420009526207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN1613Medicaid
VT0VN1613Medicaid
G56511Medicare UPIN