Healthcare Provider Details

I. General information

NPI: 1760707236
Provider Name (Legal Business Name): MICHAEL P. BAZYLEWICZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2010
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE UVM MEDICAL CENTER - DEPT. OF RADIOLOGY
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

111 COLCHESTER AVE UVM MEDICAL CENTER - DEPT. OF RADIOLOGY
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-3593
  • Fax: 802-847-4822
Mailing address:
  • Phone: 802-847-3593
  • Fax: 802-847-4822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2015-00157
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number042.0013440
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number38000
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number72630
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME154739
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: