MEDICARE: G. KENNETH DEHART JR. MD

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	2085D0003X	Diagnostic Neuroimaging (Radiology) Physician	042-0003147	VT
2	2085R0202X	Diagnostic Radiology Physician	042-0003147	VT

General Provider Information

NPI Number	:	1871758201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	G. KENNETH DEHART JR. MD

Provider Business Mailing Address
First Line	:	1298 SAVAGE POINT ROAD
Second Line	:	BOX 126
City	:	NORTH HERO
State	:	VT
Zip	:	05474-0126
Country	:	US
Telephone Number	:	802-372-6739
Fax Number	:

Provider Business Practice Location Address
First Line	:	1298 SAVAGE POINT RD.
Second Line	:	BOX 126
City	:	NORTH HERO
State	:	VT
Zip	:	05474-0126
Country	:	US
Telephone Number	:	802-372-6739
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	07/24/2008

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