Healthcare Provider Details

I. General information

NPI: 1851361992
Provider Name (Legal Business Name): PAUL J MAYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 COLCHESTER AVE
BURLINGTON VT
05401-1424
US

IV. Provider business mailing address

60 COLCHESTER AVE
BURLINGTON VT
05401-1424
US

V. Phone/Fax

Practice location:
  • Phone: 802-864-7483
  • Fax: 802-660-4337
Mailing address:
  • Phone: 802-864-7483
  • Fax: 802-660-4337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0420004407
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0420004407
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: