Healthcare Provider Details

I. General information

NPI: 1104884824
Provider Name (Legal Business Name): AFFILIATES IN OBSTETRICAL & GYNECOLOGICAL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 COLCHESTER AVE
BURLINGTON VT
05401-1417
US

IV. Provider business mailing address

96 COLCHESTER AVE
BURLINGTON VT
05401-1417
US

V. Phone/Fax

Practice location:
  • Phone: 802-658-0505
  • Fax:
Mailing address:
  • Phone: 802-658-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICK CLIFFORD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 802-658-0505