Healthcare Provider Details

I. General information

NPI: 1437634359
Provider Name (Legal Business Name): NORTHWESTERN MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 S MAIN ST
SAINT ALBANS VT
05478-2274
US

IV. Provider business mailing address

133 FAIRFIELD ST
SAINT ALBANS VT
05478-1726
US

V. Phone/Fax

Practice location:
  • Phone: 802-527-6594
  • Fax: 802-527-8187
Mailing address:
  • Phone: 802-524-5911
  • Fax: 802-527-1057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY E PIGEON
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 802-524-8954