Provider Demographics
NPI:1033544358
Name:STOWE PERSONALIZED MEDICAL CARE PLLC
Entity Type:Organization
Organization Name:STOWE PERSONALIZED MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BISBEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-253-5020
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:53 OLD FARM ROAD
Mailing Address - City:STOWE
Mailing Address - State:VT
Mailing Address - Zip Code:05672-0357
Mailing Address - Country:US
Mailing Address - Phone:802-253-5020
Mailing Address - Fax:802-253-5021
Practice Address - Street 1:53 OLD FARM ROAD
Practice Address - Street 2:
Practice Address - City:STOWE
Practice Address - State:VT
Practice Address - Zip Code:05672-0357
Practice Address - Country:US
Practice Address - Phone:802-253-5020
Practice Address - Fax:802-253-5021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0007377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTY100107338Medicare PIN