Healthcare Provider Details

I. General information

NPI: 1962415042
Provider Name (Legal Business Name): JONNA COXON GOULDING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 FISHER RD
BERLIN VT
05602-9516
US

IV. Provider business mailing address

PO BOX 547 ATT: CVMC FINANCE DEPT
BARRE VT
05641-0547
US

V. Phone/Fax

Practice location:
  • Phone: 802-225-3994
  • Fax: 802-371-5985
Mailing address:
  • Phone: 802-225-3994
  • Fax: 802-371-5985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0420009355
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number042.0009355
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: