Healthcare Provider Details

I. General information

NPI: 1811100977
Provider Name (Legal Business Name): JUSTIN P. HAND M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE SMITH 415
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

1220 N LOGAN AVE
DANVILLE IL
61832-2920
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4736
  • Fax:
Mailing address:
  • Phone: 217-474-7102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: