Provider Demographics
NPI:1952948770
Name:BROADFOOT, MORGAN (PA-C, MPAS)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:BROADFOOT
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 HOUGHTON BROOK RD
Mailing Address - Street 2:
Mailing Address - City:PUTNEY
Mailing Address - State:VT
Mailing Address - Zip Code:05346-8675
Mailing Address - Country:US
Mailing Address - Phone:802-490-1904
Mailing Address - Fax:
Practice Address - Street 1:79 MAIN STREET
Practice Address - Street 2:PUTNEY FAMILY HEALTHCARE
Practice Address - City:PUTNEY
Practice Address - State:VT
Practice Address - Zip Code:05346-8318
Practice Address - Country:US
Practice Address - Phone:802-387-5581
Practice Address - Fax:802-387-6694
Is Sole Proprietor?:No
Enumeration Date:2019-12-01
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055.0031461363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant