Healthcare Provider Details

I. General information

NPI: 1639643919
Provider Name (Legal Business Name): MICHAEL PATRICK GAFFNEY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2019
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 HOLIDAY DR STE A
WHITE RIVER JUNCTION VT
05001-2015
US

IV. Provider business mailing address

108 N MAIN ST
WHITE RIVER JUNCTION VT
05001-7056
US

V. Phone/Fax

Practice location:
  • Phone: 802-674-9400
  • Fax: 802-674-9410
Mailing address:
  • Phone: 802-296-7370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number055.0031752
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: