Provider Demographics
NPI:1184204729
Name:MANCHESTER PODIATRY
Entity Type:Organization
Organization Name:MANCHESTER PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:BUHL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:802-362-9959
Mailing Address - Street 1:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-0492
Mailing Address - Country:US
Mailing Address - Phone:607-237-2317
Mailing Address - Fax:
Practice Address - Street 1:7252 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-9531
Practice Address - Country:US
Practice Address - Phone:802-362-9962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric