Healthcare Provider Details

I. General information

NPI: 1104811884
Provider Name (Legal Business Name): JAMES BENTLEY HOLLINSHEAD P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 ALBERT CREE DR
RUTLAND VT
05701-4601
US

IV. Provider business mailing address

3 ALBERT CREE DR
RUTLAND VT
05701-4601
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 TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number30363
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: