Healthcare Provider Details

I. General information

NPI: 1134742893
Provider Name (Legal Business Name): MARATHON HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KENNEDY DR
SOUTH BURLINGTON VT
05403-7152
US

IV. Provider business mailing address

20 WINOOSKI FALLS WAY
WINOOSKI VT
05404-2228
US

V. Phone/Fax

Practice location:
  • Phone: 802-755-7201
  • Fax:
Mailing address:
  • Phone: 802-857-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JERRY FORD
Title or Position: CEO
Credential:
Phone: 802-857-0400