MEDICARE: CENTRAL VERMONT UROLOGY INC

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	208800000X	Urology Physician	0420006490	VT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CM5214	OTHER		RAIL ROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1780665471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL VERMONT UROLOGY INC

Provider Business Mailing Address
First Line	:	PO BOX 278
Second Line	:
City	:	MONTPELIER
State	:	VT
Zip	:	05601-0278
Country	:	US
Telephone Number	:	802-476-6060
Fax Number	:	802-476-6767

Provider Business Practice Location Address
First Line	:	542 BARRE MONTPELIER RD
Second Line	:	US RT 302
City	:	BARRE
State	:	VT
Zip	:	05641
Country	:	US
Telephone Number	:	802-476-6060
Fax Number	:	802-476-6767

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL JOSEPH ZAHM
Credential	:	MD
Telephone Number	:	802-476-6060

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	06/09/2008

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