Provider Demographics
NPI:1518964154
Name:DENNETT, DOUGLAS EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:EDWARD
Last Name:DENNETT
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 1:8 CARMICHAEL ST
Mailing Address - Street 2:UNIT 204
Mailing Address - City:ESSEX JCT
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3216
Mailing Address - Country:US
Mailing Address - Phone:802-872-9263
Mailing Address - Fax:802-872-8222
Practice Address - Street 1:8 CARMICHAEL ST
Practice Address - Street 2:UNIT 204
Practice Address - City:ESSEX JCT
Practice Address - State:VT
Practice Address - Zip Code:05452-3216
Practice Address - Country:US
Practice Address - Phone:802-872-9263
Practice Address - Fax:802-872-8222
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT04200079752084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00009967OtherBCBS
VT20P005OtherMVP
VT71747OtherCIGNA
VT9532Medicaid
VT9532Medicaid
VT71747OtherCIGNA