Healthcare Provider Details

I. General information

NPI: 1760448450
Provider Name (Legal Business Name): MARY K JOYCE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 COUNTY RD MT ASCUTNEY PHYSICIAN PRACTICES
WINDSOR VT
05089
US

IV. Provider business mailing address

289 COUNTY RD MT ASCUTNEY PHYSICIAN PRACTICES
WINDSOR VT
05089
US

V. Phone/Fax

Practice location:
  • Phone: 802-674-7344
  • Fax: 802-674-7314
Mailing address:
  • Phone: 802-674-7344
  • Fax: 802-674-7314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8165
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number042-0011915
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: