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General NPI Number Information
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NPI Number | 1609190164
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Entity Type | Organization
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Legal Business Name | JONATHAN E. FENTON D.O., P.C.
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Dates
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Enumeration Date | 03/26/2010
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Last Update Date | 07/30/2010
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Provider Practice Location Address
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Address Line | 321 MAIN ST SUITE C
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City | WINOOSKI
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State | VT
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Zip | 05404-1380
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Country | US
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Telephone | 802-859-0000
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Fax | 802-859-0005
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Provider Business Mailing Address
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Address Line | 321 MAIN ST SUITE C
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City | WINOOSKI
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State | VT
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Zip | 05404-1380
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Country | US
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Telephone | 802-859-0000
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Fax | 802-859-0005
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JONATHAN ERIC FENTON
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Credential | D.O., P.C.
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Telephone | 802-859-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 032-0000356
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License Number State | VT
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