Provider Demographics
NPI:1588616494
Name:BROY, LANCE F (MD)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:F
Last Name:BROY
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:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-0749
Mailing Address - Country:US
Mailing Address - Phone:802-851-8619
Mailing Address - Fax:802-851-8716
Practice Address - Street 1:272 N MAIN STREET
Practice Address - Street 2:UNIT 101
Practice Address - City:CAMBRIDGE
Practice Address - State:VT
Practice Address - Zip Code:05444
Practice Address - Country:US
Practice Address - Phone:802-644-5114
Practice Address - Fax:802-888-6075
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-3771207Q00000X
VT042.0017249207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2509931OtherMOLINA MEDICAID
OH310917085076OtherCARESOURCE MEDICAID
P00158651OtherRAILROAD MEDICARE
OH2509931Medicaid
OH000000181872OtherUNISON MEDICAID
000000349281OtherANTHEM BCBS
001714163OtherMOUNTAIN STATE BCBS
WV3810001009Medicaid
VT6714443Medicaid
WV3810001009Medicaid