Healthcare Provider Details

I. General information

NPI: 1033142922
Provider Name (Legal Business Name): MICHAEL A MARKOWITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2987 VT ROUTE 22A
SHOREHAM VT
05770-9728
US

IV. Provider business mailing address

71 ALLEN ST STE 402
RUTLAND VT
05701-4570
US

V. Phone/Fax

Practice location:
  • Phone: 802-897-7000
  • Fax:
Mailing address:
  • Phone: 802-468-2928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number25607
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25607
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: