Healthcare Provider Details

I. General information

NPI: 1588616494
Provider Name (Legal Business Name): LANCE F. BROY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/08/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 N MAIN STREET UNIT 101
CAMBRIDGE VT
05444
US

IV. Provider business mailing address

PO BOX 749
MORRISVILLE VT
05661-0749
US

V. Phone/Fax

Practice location:
  • Phone: 802-644-5114
  • Fax: 802-888-6075
Mailing address:
  • Phone: 802-851-8619
  • Fax: 802-851-8716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-08-3771
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number042.0017249
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: