Provider Demographics
NPI:1376878025
Name:MORGAN, TODD (PA)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:MORGAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:ATT: CVMC FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-371-4239
Mailing Address - Fax:802-371-4237
Practice Address - Street 1:1311 BARRE- MONTPELIER RD
Practice Address - Street 2:CVMC EXPRESSCARE
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-0000
Practice Address - Country:US
Practice Address - Phone:802-371-4239
Practice Address - Fax:802-371-4237
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2015-10-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MAPA3883363A00000X
VT055.0031257363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT9000782Medicaid