Healthcare Provider Details

I. General information

NPI: 1316903974
Provider Name (Legal Business Name): JAMES L LONTINE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 MAPLE STREET
ISLAND POND VT
05846
US

IV. Provider business mailing address

165 SHERMAN DR
ST JOHNSBURY VT
05819-9811
US

V. Phone/Fax

Practice location:
  • Phone: 802-723-4300
  • Fax: 802-723-4544
Mailing address:
  • Phone: 802-748-9405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0550030123
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: