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NPI Code Detail

MEDICARE: MICHAEL ANDREW CHAMP

MEDICARE: MICHAEL ANDREW CHAMP
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
12084P0800XPsychiatry Physician042.0016281VT
22084P0804XChild & Adolescent Psychiatry Physician042.0016281VT

General Provider Information

NPI Number : 1295231660
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL ANDREW CHAMP
Provider Business Mailing Address
First Line : 28 MANSEAU ST
Second Line :
City : WINOOSKI
State : VT
Zip : 05404-1546
Country : US
Telephone Number : 802-847-5162
Fax Number : 802-315-4168
Provider Business Practice Location Address
First Line : 102 S WINOOSKI AVE
Second Line :
City : BURLINGTON
State : VT
Zip : 05401-7406
Country : US
Telephone Number : 802-488-6000
Fax Number : 802-488-6919
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2018
Last Update Date : 04/29/2025

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Directions to “ MICHAEL ANDREW CHAMP ” Practice Location

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