Provider Demographics
NPI:1467537431
Name:DR. SIMON DREW MD PC
Entity Type:Organization
Organization Name:DR. SIMON DREW MD PC
Other - Org Name:SIMON P. DREW, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DREW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-442-3800
Mailing Address - Street 1:140 HOSPITAL DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-5009
Mailing Address - Country:US
Mailing Address - Phone:802-442-3800
Mailing Address - Fax:802-442-3855
Practice Address - Street 1:140 HOSPITAL DR
Practice Address - Street 2:SUITE 203
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-5009
Practice Address - Country:US
Practice Address - Phone:802-442-3800
Practice Address - Fax:802-442-3855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420010815174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010955Medicaid
VT1010955Medicaid
VN3945Medicare ID - Type Unspecified