Provider Demographics
NPI:1649245382
Name:BOVE, ERNEST M (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:M
Last Name:BOVE
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 666
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05702
Mailing Address - Country:US
Mailing Address - Phone:802-775-6006
Mailing Address - Fax:802-773-4946
Practice Address - Street 1:145 ALLEN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701
Practice Address - Country:US
Practice Address - Phone:802-775-6006
Practice Address - Fax:802-773-4946
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT42007313208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT42007313OtherVT LICENSE
VT42007313Medicaid
VT0006431Medicaid
VT42007313Medicaid
VTVT643101Medicare PIN
VT42007313OtherVT LICENSE