Provider Demographics
NPI:1801895818
Name:DONAVAN, NANCY SCATTERGOOD (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:SCATTERGOOD
Last Name:DONAVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:LEE
Other - Last Name:SCATTERGOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2074 S STREAM RD
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-8886
Mailing Address - Country:US
Mailing Address - Phone:802-681-8528
Mailing Address - Fax:802-442-6703
Practice Address - Street 1:2074 S STREAM RD
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-8886
Practice Address - Country:US
Practice Address - Phone:802-681-8528
Practice Address - Fax:802-442-6703
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420006890207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00028237OtherBLUE CROSS/BLUE SHIELD
VT080066554OtherRAILROAD MEDICARE
4482963OtherAETNA
VT0005554Medicaid
08198OtherMVP
10002929OtherCDPHP
VT8000200OtherLADIES FIRST
VTB85673Medicare UPIN
VT0005554Medicaid