Provider Demographics
NPI:1891839403
Name:SEVERINGHAUS, JOHN MERRILL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MERRILL
Last Name:SEVERINGHAUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:VT
Mailing Address - Zip Code:05055-0234
Mailing Address - Country:US
Mailing Address - Phone:802-649-1323
Mailing Address - Fax:802-649-1323
Practice Address - Street 1:2122 LOWER PLN
Practice Address - Street 2:MERRY MEADOW FARM
Practice Address - City:BRADFORD
Practice Address - State:VT
Practice Address - Zip Code:05033-8936
Practice Address - Country:US
Practice Address - Phone:802-222-4412
Practice Address - Fax:802-222-5422
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36863207R00000X
NH72372084A0401X, 2084P0800X
VT2084A0401X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00009936Medicaid
E12737Medicare UPIN
VT00009936Medicaid