Healthcare Provider Details

I. General information

NPI: 1124551601
Provider Name (Legal Business Name): MICHAEL HARRISON PARKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVENUE MAIN CAMPUS, MAIN PAVILION, LEVEL 5
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

111 COLCHESTER AVE MAIN CAMPUS, MAIN PAVILION, LEVEL 5
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4548
  • Fax: 802-847-3581
Mailing address:
  • Phone: 802-847-4548
  • Fax: 802-847-3581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036.159691
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number036159691
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number042.0017730
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: