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General NPI Number Information
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NPI Number | 1184640377
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Entity Type | Individual
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Provider Name | EDWIN G BOVILL MD
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Gender | Male
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 111 COLCHESTER AVE FLETCHER ALLEN HEALTH CARE, PATHOLOGY
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City | BURLINGTON
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State | VT
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Zip | 05401-1473
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Country | US
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Telephone | 802-656-0359
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Fax | 802-656-8892
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Provider Business Mailing Address
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Address Line | 414 CLEARWATER RD
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City | SHELBURNE
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State | VT
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Zip | 05482-7725
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Country | US
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Telephone | 802-985-8257
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Fax | 802-656-8892
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 042-0006429
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License Number State | VT
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