MEDICARE: MARK IVERSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	042.0007517	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003878349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK IVERSON MD

Provider Business Mailing Address
First Line	:	81 RIVER ST
Second Line	:	SUITE 204
City	:	MONTPELIER
State	:	VT
Zip	:	05602-3792
Country	:	US
Telephone Number	:	802-229-9554
Fax Number	:	802-229-5906

Provider Business Practice Location Address
First Line	:	81 RIVER ST
Second Line	:	SUITE 204
City	:	MONTPELIER
State	:	VT
Zip	:	05602-3792
Country	:	US
Telephone Number	:	802-229-9554
Fax Number	:	802-229-5906

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	11/03/2016

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Directions to “ MARK IVERSON MD” Practice Location

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