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General NPI Number Information
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NPI Number | 1518181569
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Entity Type | Individual
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Provider Name | MIA FAY HOCKETT M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 06/02/2010
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Provider Practice Location Address
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Address Line | 111 COLCHESTER AVE
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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 | 802-874-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 81 S WILLIAMS ST UNIT 306
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City | BURLINGTON
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State | VT
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Zip | 05401-3405
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Country | US
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Telephone | 802-658-2130
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0420011959
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License Number State | VT
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