Provider Demographics
NPI:1780690172
Name:VERMONT PHYSICIANS CLINIC
Entity Type:Organization
Organization Name:VERMONT PHYSICIANS CLINIC
Other - Org Name:DAVID S TAGER MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:TAGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-775-1711
Mailing Address - Street 1:11 COMMONS ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4652
Mailing Address - Country:US
Mailing Address - Phone:802-775-1711
Mailing Address - Fax:802-770-5851
Practice Address - Street 1:11 COMMONS ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4652
Practice Address - Country:US
Practice Address - Phone:802-775-1711
Practice Address - Fax:802-770-5851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT58781OtherBCBS
VT1008927Medicaid
VT58781OtherBCBS