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General NPI Number Information
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NPI Number | 1952437543
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Entity Type | Individual
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Provider Name | PHILIP J DAVIGNON M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 145 PINE HAVEN SHORES RD
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City | SHELBURNE
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State | VT
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Zip | 05482-7703
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Country | US
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Telephone | 802-985-9905
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Fax |
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Provider Business Mailing Address
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Address Line | 572 SOUTHRIDGE RD
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City | WILLISTON
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State | VT
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Zip | 05495-5240
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Country | US
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Telephone | 802-985-9905
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Fax |
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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 | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 55420
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License Number State | MA
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