MEDICARE: PHILIP J DAVIGNON 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
1	2083X0100X	Occupational Medicine Physician	55420	MA

General Provider Information

NPI Number	:	1952437543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP J DAVIGNON M.D.

Provider Business Mailing Address
First Line	:	572 SOUTHRIDGE RD
Second Line	:
City	:	WILLISTON
State	:	VT
Zip	:	05495-5240
Country	:	US
Telephone Number	:	802-985-9905
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 PINE HAVEN SHORES RD
Second Line	:
City	:	SHELBURNE
State	:	VT
Zip	:	05482-7703
Country	:	US
Telephone Number	:	802-985-9905
Fax Number	:

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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