Healthcare Provider Details

I. General information

NPI: 1730107749
Provider Name (Legal Business Name): SETH PERRY HARLOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE MAIN PAVILION-2
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

144 OSGOOD HILL RD
ESSEX JCT VT
05452-2305
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-2262
  • Fax: 802-847-0574
Mailing address:
  • Phone: 802-847-2262
  • Fax: 802-847-0574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number042-0008991
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: