| Derick E. Vergne, Md Pllc | |
|
179 Great Rd Ste 201 Acton MA 01720-5774 | |
| (857) 239-1911 | |
| (617) 544-0937 |
| Full Name | Derick E. Vergne, Md Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 179 Great Rd Ste 201, Acton, Massachusetts |
| Authorized Official Name and Position | Derick Vergne (OWNER/PROVIDER) |
| Authorized Official Contact | 8572391911 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Derick E. Vergne, Md Pllc 179 Great Rd Ste 201 Acton MA 01720 Ph: (857) 239-1911 | Derick E. Vergne, Md Pllc 179 Great Rd Ste 201 Acton MA 01720-5774 Ph: (857) 239-1911 |
| NPI Number | 1003536798 |
|---|---|
| Provider Enumeration Date | 09/01/2022 |
| Last Update Date | 09/25/2023 |
| Certification Date | 09/25/2023 |
| Medicare PECOS PAC ID | 2062888688 |
|---|---|
| Medicare Enrollment ID | O20221021001024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003536798 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Derick E Vergne |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013066083 PECOS PAC ID: 6305928110 Enrollment ID: I20111229000151 |
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