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General NPI Number Information
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NPI Number | 1700835741
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Entity Type | Organization
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Legal Business Name | BENNINGTON FAMILY PRACTICE PLLC
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 339 DEWEY ST
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City | BENNINGTON
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State | VT
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Zip | 05201-2253
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Country | US
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Telephone | 802-447-1191
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Fax | 802-442-6614
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Provider Business Mailing Address
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Address Line | 339 DEWEY ST
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City | BENNINGTON
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State | VT
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Zip | 05201-2253
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Country | US
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Telephone | 802-447-1191
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Fax | 802-442-6614
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. ELIZABETH J ELLINGSEN
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Credential | MHA
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Telephone | 802-447-1191
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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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