Provider Demographics
NPI:1801891882
Name:NUNLIST, MARK M (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:M
Last Name:NUNLIST
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Gender:M
Credentials:MD
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Mailing Address - Street 1:331 OLCOTT DR
Mailing Address - Street 2:STE U3
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-9601
Mailing Address - Country:US
Mailing Address - Phone:802-295-6132
Mailing Address - Fax:802-295-1358
Practice Address - Street 1:331 OLCOTT DR
Practice Address - Street 2:STE U3
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-9601
Practice Address - Country:US
Practice Address - Phone:802-295-6132
Practice Address - Fax:802-295-1358
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2015-06-11
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Provider Licenses
StateLicense IDTaxonomies
VT042-0006923207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT8000076Medicaid
VT5593Medicaid
VTY400215412OtherMEDICARE PTAN
VT8000076Medicaid