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NPI Code Detail

MEDICARE: DERRICK L. BLODGETT BA

MEDICARE: DERRICK L. BLODGETT BA
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
1171M00000XCase Manager/Care CoordinatorVT

General Provider Information

NPI Number : 1861322844
Entity Type Code : Individual
Provider Name (Legal Business Name) : DERRICK L. BLODGETT BA
Provider Business Mailing Address
First Line : PO BOX 647
Second Line :
City : MONTPELIER
State : VT
Zip : 05601-0647
Country : US
Telephone Number : 802-229-1399
Fax Number : 802-223-8623
Provider Business Practice Location Address
First Line : 9 HEATON ST
Second Line :
City : MONTPELIER
State : VT
Zip : 05602-2489
Country : US
Telephone Number : 802-223-6328
Fax Number : 802-229-8004
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2026
Last Update Date : 05/21/2026

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