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General NPI Number Information
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NPI Number | 1780702118
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ASSOCIATES, P.C.
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 GENERAL WING RD
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City | RUTLAND
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State | VT
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Zip | 05701-4681
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Country | US
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Telephone | 802-786-2491
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Fax | 802-775-6141
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Provider Business Mailing Address
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Address Line | 1 GENERAL WING RD
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City | RUTLAND
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State | VT
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Zip | 05701-4681
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Country | US
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Telephone | 802-786-2491
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Fax | 802-775-6141
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CAROL E. PERKINS
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Credential |
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Telephone | 802-786-2491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0420008063
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License Number State | VT
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