Healthcare Provider Details

I. General information

NPI: 1750596110
Provider Name (Legal Business Name): BENNINGTON COLLEGE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COLLEGE DRIVE
BENNINGTON VT
05201-0006
US

IV. Provider business mailing address

1 COLLEGE DRIVE
BENNINGTON VT
05201-0006
US

V. Phone/Fax

Practice location:
  • Phone: 802-440-4426
  • Fax: 802-440-4427
Mailing address:
  • Phone: 802-440-4426
  • Fax: 802-440-4427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0260009599
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0260008617
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0260029265
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0420010651
License Number StateVT

VIII. Authorized Official

Name: DR. RANDALL S ANSELMO
Title or Position: DIRECTOR OF HEALTH SERVICES
Credential: MD
Phone: 802-440-4426