Healthcare Provider Details

I. General information

NPI: 1144240474
Provider Name (Legal Business Name): PORTER HOSPITAL DBA CEDAR LEDGE FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 COURT ST CEDAR LODGE FAMILY PRACTICE
MIDDLEBURY VT
05753-1408
US

IV. Provider business mailing address

104 PORTER DR
MIDDLEBURY VT
05753-8527
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-7185
  • Fax: 802-388-3445
Mailing address:
  • Phone: 802-388-8808
  • Fax: 802-388-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DUNCAN S BRINES
Title or Position: CFO
Credential: CFO
Phone: 802-388-4701