Healthcare Provider Details

I. General information

NPI: 1689605073
Provider Name (Legal Business Name): JOHN M WRIGHT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 S UNION ST STE 4C
BURLINGTON VT
05401-4859
US

IV. Provider business mailing address

444 S UNION ST STE 4C
BURLINGTON VT
05401-4859
US

V. Phone/Fax

Practice location:
  • Phone: 802-338-5636
  • Fax: 802-284-3163
Mailing address:
  • Phone: 802-338-5636
  • Fax: 802-860-4646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0420010621
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: