Healthcare Provider Details

I. General information

NPI: 1699798900
Provider Name (Legal Business Name): MARK PHILLIPPE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE FAHC, ACC EP-4
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

74 WILDWOOD DR
SHELBURNE VT
05482-6787
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-5112
  • Fax: 802-847-5626
Mailing address:
  • Phone: 802-985-3115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number042-0010320
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number042-0010320
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number042-0010320
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: