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General NPI Number Information
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NPI Number | 1538221502
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Entity Type | Organization
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Legal Business Name | NANCY SCATTERGOOD DONAVAN MD
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 2074 S STREAM RD
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City | BENNINGTON
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State | VT
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Zip | 05201-8886
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Country | US
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Telephone | 802-379-5874
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Fax | 802-442-6703
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Provider Business Mailing Address
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Address Line | 2074 S STREAM RD
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City | BENNINGTON
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State | VT
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Zip | 05201-8886
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Country | US
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Telephone | 802-379-5874
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Fax | 802-442-6703
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. NANCY LEE SCATTERGOOD
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Credential | MD
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Telephone | 802-379-5874
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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 | 0420010148
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1010021887
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License Number State | VT
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0420006890
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License Number State | VT
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