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General NPI Number Information
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NPI Number | 1245266808
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Entity Type | Individual
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Provider Name | JON-RICHARD KNOFF M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 09/29/2014
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Provider Practice Location Address
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Address Line | 44 S MAIN ST
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City | RANDOLPH
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State | VT
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Zip | 05060-1381
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Country | US
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Telephone | 802-728-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 404 STOCK FARM RD
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City | RANDOLPH
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State | VT
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Zip | 05060-9103
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Country | US
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Telephone | 802-728-4570
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 0420011276
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License Number State | VT
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