Healthcare Provider Details

I. General information

NPI: 1801895818
Provider Name (Legal Business Name): NANCY SCATTERGOOD DONAVAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY LEE SCATTERGOOD M.D.

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 S STREAM RD
BENNINGTON VT
05201-8886
US

IV. Provider business mailing address

2074 S STREAM RD
BENNINGTON VT
05201-8886
US

V. Phone/Fax

Practice location:
  • Phone: 802-681-8528
  • Fax: 802-442-6703
Mailing address:
  • Phone: 802-681-8528
  • Fax: 802-442-6703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0420006890
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: