Provider Demographics
NPI:1083931778
Name:SOUTHWESTERN VERMONT MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:SOUTHWESTERN VERMONT MEDICAL CENTER, INC.
Other - Org Name:SVMC PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVOTNY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-447-5014
Mailing Address - Street 1:140 HOSPITAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-5009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 HOSPITAL DR
Practice Address - Street 2:SUITE 204
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-5009
Practice Address - Country:US
Practice Address - Phone:802-447-0607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWESTERN VERMONT MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty