MEDICARE: MICHAEL E. SCOVNER MD

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
1	207R00000X	Internal Medicine Physician	042-0007746	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376615534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL E. SCOVNER MD

Provider Business Mailing Address
First Line	:	236 MAIN ST
Second Line	:
City	:	POULTNEY
State	:	VT
Zip	:	05764-1106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	236 MAIN ST
Second Line	:
City	:	POULTNEY
State	:	VT
Zip	:	05764-1106
Country	:	US
Telephone Number	:	802-287-2269
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/09/2020

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