MEDICARE: JOHN PENOYAR MA

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	103TC0700X	Clinical Psychologist	047-0000630	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	:	1548215122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN PENOYAR MA

Provider Business Mailing Address
First Line	:	1041 POND RD
Second Line	:
City	:	HINESBURG
State	:	VT
Zip	:	05461-9196
Country	:	US
Telephone Number	:	802-860-8435
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MILL ST
Second Line	:	SUITE 204
City	:	BURLINGTON
State	:	VT
Zip	:	05401-1530
Country	:	US
Telephone Number	:	802-860-8435
Fax Number	:

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/08/2007

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Directions to “ JOHN PENOYAR MA” Practice Location

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