Healthcare Provider Details

I. General information

NPI: 1366524795
Provider Name (Legal Business Name): SHAFTSBURY MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 VT. RTE. 7A
SHAFTSBURY VT
05262-0379
US

IV. Provider business mailing address

PO BOX 379
SHAFTSBURY VT
05262-0379
US

V. Phone/Fax

Practice location:
  • Phone: 802-442-8531
  • Fax: 802-442-1503
Mailing address:
  • Phone: 802-442-8531
  • Fax: 802-442-1503

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: DR. DAVID E KING
Title or Position: PRESIDENT
Credential: M.D.
Phone: 802-442-8531