Provider Demographics
NPI:1225011208
Name:SIMCOE, DAVID NICHOLAS (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NICHOLAS
Last Name:SIMCOE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7134
Mailing Address - Country:US
Mailing Address - Phone:802-878-8131
Mailing Address - Fax:802-879-6853
Practice Address - Street 1:586 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7134
Practice Address - Country:US
Practice Address - Phone:802-878-8131
Practice Address - Fax:802-879-6853
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002376207Q00000X
VT0320000562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00322426OtherRAILROAD MEDICARE
270890200OtherPASSPORT ADVANTAGE
VT0320000562OtherSTATE LICENSE
IN7027371OtherAETNA
P00322426OtherRAILROAD MEDICARE
VT0320000562OtherSTATE LICENSE
IN200535250Medicaid
270890200OtherPASSPORT ADVANTAGE
IN200535250Medicaid
P00322426OtherRAILROAD MEDICARE