Healthcare Provider Details

I. General information

NPI: 1881686533
Provider Name (Legal Business Name): MARK A HEALEY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 BLAKELY RD SUITE 100
COLCHESTER VT
05446-3901
US

IV. Provider business mailing address

308 BLAKELY RD SUITE 100
COLCHESTER VT
05446-3901
US

V. Phone/Fax

Practice location:
  • Phone: 802-658-5600
  • Fax: 802-658-5605
Mailing address:
  • Phone: 802-658-5600
  • Fax: 802-658-5605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateVT

VIII. Authorized Official

Name: MARK A HEALEY
Title or Position: OWNER
Credential: MD
Phone: 802-658-5606