Healthcare Provider Details

I. General information

NPI: 1508373572
Provider Name (Legal Business Name): FAMILY MEDICINE PARTNERS - VERMONT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 12/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 KNIGHT LN STE 10
WILLISTON VT
05495-9308
US

IV. Provider business mailing address

66 KNIGHT LN STE 10
WILLISTON VT
05495-9308
US

V. Phone/Fax

Practice location:
  • Phone: 802-872-4343
  • Fax: 802-872-0907
Mailing address:
  • Phone: 802-872-4343
  • Fax: 802-872-0907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateVT

VIII. Authorized Official

Name: JON ASSELIN
Title or Position: COO
Credential:
Phone: 802-872-4326