Healthcare Provider Details

I. General information

NPI: 1124261987
Provider Name (Legal Business Name): JESSICA E O'NEIL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 HOSPITAL LOOP
BERLIN VT
05602-9523
US

IV. Provider business mailing address

PO BOX 647
MONTPELIER VT
05601-0647
US

V. Phone/Fax

Practice location:
  • Phone: 802-229-0591
  • Fax: 802-223-3667
Mailing address:
  • Phone: 802-229-0591
  • Fax: 802-223-3667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number032.0080694
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: