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4628 Main Street Newbury VT 05051-9775 | |
(802) 866-3000 | |
(802) 866-3012 |
Full Name | |
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Speciality | Family Medicine |
Location | 4628 Main Street, Newbury, Vermont |
Authorized Official Name and Position | Melaine C Lawrence (OWNER) |
Authorized Official Contact | 8028663000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 37 Newbury VT 05051-0037 Ph: (802) 866-3000 | 4628 Main Street Newbury VT 05051-9775 Ph: (802) 866-3000 |
NPI Number | 1669792271 |
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Provider Enumeration Date | 06/04/2010 |
Last Update Date | 11/09/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1669792271 | NPI | - | NPPES |
1017789 | Medicaid | VT | |
30209633 | Medicaid | NH |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 207Q00000X (Vermont) | Primary |