Provider Demographics
NPI:1649375163
Name:KNIGHT, STEVEN J
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:
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 64824
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05406-4824
Mailing Address - Country:US
Mailing Address - Phone:802-655-0058
Mailing Address - Fax:802-655-3647
Practice Address - Street 1:463 MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-5966
Practice Address - Country:US
Practice Address - Phone:802-655-0058
Practice Address - Fax:802-655-3647
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0000000000000002085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010306Medicaid
VT327097Medicare ID - Type UnspecifiedVT MEDICARE