Healthcare Provider Details

I. General information

NPI: 1821083650
Provider Name (Legal Business Name): MELBOURNE DUNCAN BOYNTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 ALLEN ST
RUTLAND VT
05701-4560
US

IV. Provider business mailing address

160 ALLEN ST
RUTLAND VT
05701-4560
US

V. Phone/Fax

Practice location:
  • Phone: 802-775-2937
  • Fax: 802-773-0934
Mailing address:
  • Phone: 802-775-2937
  • Fax: 802-773-0934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0420009554
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number042.0009554
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: