Healthcare Provider Details

I. General information

NPI: 1497828859
Provider Name (Legal Business Name): CLIFTON FREDERICK LORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 HOLIDAY DR
WHITE RIVER JUNCTION VT
05001-2011
US

IV. Provider business mailing address

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number0420007259
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: