Healthcare Provider Details

I. General information

NPI: 1528023116
Provider Name (Legal Business Name): EMIL P. MISKOVSKY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 HOSPITAL DR SUITE 215
BENNINGTON VT
05201-5009
US

IV. Provider business mailing address

140 HOSPITAL DR SUITE 215
BENNINGTON VT
05201-5009
US

V. Phone/Fax

Practice location:
  • Phone: 802-442-4785
  • Fax:
Mailing address:
  • Phone: 802-442-4785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EMIL P. MISKOVSKY
Title or Position: OWNER
Credential: M.D.
Phone: 802-442-4785