Healthcare Provider Details

I. General information

NPI: 1205914884
Provider Name (Legal Business Name): SPENCER L. BLACKMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 SHELBURNE RD STE 102
BURLINGTON VT
05401-6947
US

IV. Provider business mailing address

462 SHELBURNE RD STE 102
BURLINGTON VT
05401-6947
US

V. Phone/Fax

Practice location:
  • Phone: 802-227-4417
  • Fax: 802-227-6897
Mailing address:
  • Phone: 802-227-4417
  • Fax: 802-227-6897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberV4643
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number84995
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2020-04415
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number296496
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number254843
License Number StateMA
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number042.0013274
License Number StateVT
# 7
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME43528
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA88542
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: