Provider Demographics
NPI:1881686533
Name:MARK A HEALEY MD PC
Entity type:Organization
Organization Name:MARK A HEALEY MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEALEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-658-5606
Mailing Address - Street 1:308 BLAKELY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-3901
Mailing Address - Country:US
Mailing Address - Phone:802-658-5600
Mailing Address - Fax:802-658-5605
Practice Address - Street 1:308 BLAKELY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-3901
Practice Address - Country:US
Practice Address - Phone:802-658-5600
Practice Address - Fax:802-658-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTDD8475OtherRR MEDICARE
VT1009516Medicaid
F73722Medicare UPIN
VT1009516Medicaid