MEDICARE: TIMBER LANE ALLERGY & ASTHMA ASSOCIATES, PC

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	207K00000X	Allergy & Immunology Physician		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
3	TOO2520	OTHER		TRICARE
4	28818	OTHER	VT	BLUE CROSS BLUE SHIELD VT

General Provider Information

NPI Number	:	1457356818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMBER LANE ALLERGY & ASTHMA ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	53 TIMBER LN
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-5201
Country	:	US
Telephone Number	:	802-864-0294
Fax Number	:	802-864-3779

Provider Business Practice Location Address
First Line	:	53 TIMBER LN
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-5201
Country	:	US
Telephone Number	:	802-864-0294
Fax Number	:	802-864-3779

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDWARD F KENT JR.
Credential	:	MD
Telephone Number	:	802-864-0294

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	08/22/2020

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