Healthcare Provider Details

I. General information

NPI: 1750394979
Provider Name (Legal Business Name): RICHARD HARRY DOOLEY PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

586 OAK HILL RD
WILLISTON VT
05495
US

IV. Provider business mailing address

586 OAK HILL RD
WILLISTON VT
05495
US

V. Phone/Fax

Practice location:
  • Phone: 802-878-8131
  • Fax: 802-879-6853
Mailing address:
  • Phone: 802-878-8131
  • Fax: 802-879-6853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0550030450
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: