Healthcare Provider Details

I. General information

NPI: 1609193184
Provider Name (Legal Business Name): SCOTT DANIEL LEGUNN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE. UVM MEDICAL CENTER - MEDICINE/RHEUMATOLOGY
BURLINGTON VT
05401
US

IV. Provider business mailing address

111 COLCHESTER AVE. UVM MEDICAL CENTER - MEDICINE/RHEUMATOLOGY
BURLINGTON VT
05401
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4574
  • Fax: 802-847-9695
Mailing address:
  • Phone: 802-847-4574
  • Fax: 802-847-9695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number042.0013171
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: