Healthcare Provider Details

I. General information

NPI: 1154483543
Provider Name (Legal Business Name): UPPER VALLEY PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 UPPER PLAIN
BRADFORD VT
05033
US

IV. Provider business mailing address

331 UPPER PLAIN
BRADFORD VT
05033
US

V. Phone/Fax

Practice location:
  • Phone: 802-222-4722
  • Fax: 802-222-4709
Mailing address:
  • Phone: 802-222-4722
  • Fax: 802-222-4709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK STEVEN HARRIS
Title or Position: OWNER
Credential: MD
Phone: 802-222-4722