Provider Demographics
NPI:1285672501
Name:MACHANIC, P BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:P
Middle Name:BRIAN
Last Name:MACHANIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 MT PHILO RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:VT
Mailing Address - Zip Code:05445-9345
Mailing Address - Country:US
Mailing Address - Phone:802-310-5634
Mailing Address - Fax:802-527-0797
Practice Address - Street 1:156 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1561
Practice Address - Country:US
Practice Address - Phone:802-527-7787
Practice Address - Fax:802-527-0797
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420008124207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTP00147092OtherRAILROAD MEDICARE
VT0VN1076Medicaid
VT0VN1076Medicaid
VTB81121Medicare UPIN
VTVN107601Medicare PIN