Healthcare Provider Details

I. General information

NPI: 1952236713
Provider Name (Legal Business Name): FLYNN E. VAN GROUW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 BARRE ST
MONTPELIER VT
05602-3510
US

IV. Provider business mailing address

PO BOX 647
MONTPELIER VT
05601-0647
US

V. Phone/Fax

Practice location:
  • Phone: 802-828-3983
  • Fax: 802-223-0842
Mailing address:
  • Phone: 802-229-1399
  • Fax: 802-223-8623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number193.0000034
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: