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NPI Code Detail

MEDICARE: DR. JOHANNES CHRISTIAN NUNNINK M.D.

MEDICARE: DR. JOHANNES CHRISTIAN NUNNINK M.D.
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
1207RX0202XMedical Oncology Physician042-0006659VT

Other Identifiers

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

General Provider Information

NPI Number : 1861499964
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHANNES CHRISTIAN NUNNINK M.D.
Provider Business Mailing Address
First Line : PO BOX 1063
Second Line : 111 COLCHESTER AVE
City : BURLINGTON
State : VT
Zip : 05402-1063
Country : US
Telephone Number : 802-847-5465
Fax Number : 802-656-5493
Provider Business Practice Location Address
First Line : 111 COLCHESTER AVE
Second Line :
City : BURLINGTON
State : VT
Zip : 05401-1473
Country : US
Telephone Number : 802-656-0546
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2005
Last Update Date : 02/13/2014

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