Provider Demographics
NPI:1841596160
Name:GOLDEN, MATTHEW H (LAC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:H
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 S CHAMPLAIN ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4717
Mailing Address - Country:US
Mailing Address - Phone:802-651-9388
Mailing Address - Fax:
Practice Address - Street 1:257 S CHAMPLAIN ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4717
Practice Address - Country:US
Practice Address - Phone:802-651-9388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091.0000194171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist