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General NPI Number Information
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NPI Number | 1770015091
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Entity Type | Individual
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Provider Name | SAMUEL MCCORD MD
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Gender | Male
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 07/27/2021
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Provider Practice Location Address
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Address Line | 1 MEDICAL CENTER DR DHMC DEPARTMENT OF PSYCHIATRY
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City | LEBANON
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State | NH
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Zip | 03756-1000
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Country | US
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Telephone | 859-803-5186
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Fax |
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Provider Business Mailing Address
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Address Line | 160 ALLEN ST
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City | RUTLAND
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State | VT
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Zip | 05701-4560
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Country | US
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Telephone | 802-747-3715
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Fax | 802-747-4471
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 042.0014907
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License Number State | VT
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