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General NPI Number Information
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NPI Number | 1609079763
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Entity Type | Organization
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Legal Business Name | CENTER FOR INTEGRATIVE MEDICINE
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 69 ALLEN ST SUITE 9
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City | RUTLAND
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State | VT
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Zip | 05701-4564
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Country | US
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Telephone | 802-747-7730
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Fax | 802-773-1609
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Provider Business Mailing Address
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Address Line | 69 ALLEN ST SUITE 9
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City | RUTLAND
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State | VT
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Zip | 05701-4564
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Country | US
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Telephone | 802-747-7730
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Fax | 802-773-1609
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Authorized Official
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Title or Position | OWNER
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Name | MARK J. BUCKSBAUM
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Credential | M.D.
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Telephone | 802-747-7730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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