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NPI Code Detail

MEDICARE: MARY E GADOS MSPT

MEDICARE: MARY E GADOS MSPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist040-0003314VT
2174400000XSpecialist020816-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
200058693OTHERVTBC/BS
3OOO3314OTHERVTVT MANAGED CARE
4385696OTHERVTMVP

General Provider Information

NPI Number : 1164479978
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY E GADOS MSPT
Provider Business Mailing Address
First Line : 23 SAN REMO DR
Second Line : SUITE 101
City : SOUTH BURLINGTON
State : VT
Zip : 05403-6343
Country : US
Telephone Number : 802-865-0010
Fax Number : 802-865-0050
Provider Business Practice Location Address
First Line : 23 SAN REMO DR
Second Line : SUITE 101
City : SOUTH BURLINGTON
State : VT
Zip : 05403-6343
Country : US
Telephone Number : 802-865-0010
Fax Number : 802-865-0050
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2006
Last Update Date : 07/08/2007

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Directions to “ MARY E GADOS MSPT” Practice Location

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