Provider Demographics
NPI:1629225149
Name:FULL SPECTRUM MIDWIFERY PC
Entity Type:Organization
Organization Name:FULL SPECTRUM MIDWIFERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM
Authorized Official - Phone:802-860-2229
Mailing Address - Street 1:289 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8320
Mailing Address - Country:US
Mailing Address - Phone:802-860-2229
Mailing Address - Fax:
Practice Address - Street 1:289 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8320
Practice Address - Country:US
Practice Address - Phone:802-860-2229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT107-0000004176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008774Medicaid