Provider Demographics
NPI:1487045506
Name:PLANNED PARENTHOOD OF NORTHERN NEW ENGLAND
Entity Type:Organization
Organization Name:PLANNED PARENTHOOD OF NORTHERN NEW ENGLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:JB
Authorized Official - Last Name:GREER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-448-9719
Mailing Address - Street 1:128 LAKESIDE AVE STE 301
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5906
Mailing Address - Country:US
Mailing Address - Phone:802-448-9719
Mailing Address - Fax:
Practice Address - Street 1:1641 ROUTE 7 S
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-8806
Practice Address - Country:US
Practice Address - Phone:802-388-2765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0006041Medicaid
VTVT6041Medicare PIN