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General NPI Number Information
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NPI Number | 1417274663
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Entity Type | Organization
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Legal Business Name | NORTHWESTERN MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 04/28/2010
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Last Update Date | 08/27/2021
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Provider Practice Location Address
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Address Line | 260 CREST RD
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City | SAINT ALBANS
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State | VT
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Zip | 05478-9503
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Country | US
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Telephone | 802-524-8805
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Fax | 802-524-8488
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Provider Business Mailing Address
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Address Line | 133 FAIRFIELD ST
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City | SAINT ALBANS
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State | VT
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Zip | 05478-1726
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Country | US
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Telephone | 802-524-5911
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Fax | 802-527-1057
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MARY PIGEON
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Credential |
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Telephone | 802-524-8954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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