Provider Demographics
NPI: | 1982108908 |
---|---|
Name: | SWINEHART, MEGHAN ELIZABETH (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | MEGHAN |
Middle Name: | ELIZABETH |
Last Name: | SWINEHART |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | MEGHAN |
Other - Middle Name: | ELIZABETH |
Other - Last Name: | REYNOLDS |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | MD |
Mailing Address - Street 1: | PO BOX 905 |
Mailing Address - Street 2: | |
Mailing Address - City: | ST JOHNSBURY |
Mailing Address - State: | VT |
Mailing Address - Zip Code: | 05819-0905 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 802-748-8141 |
Mailing Address - Fax: | 802-748-4098 |
Practice Address - Street 1: | 97 SHERMAN DR STE 1 |
Practice Address - Street 2: | |
Practice Address - City: | ST JOHNSBURY |
Practice Address - State: | VT |
Practice Address - Zip Code: | 05819-9280 |
Practice Address - Country: | US |
Practice Address - Phone: | 802-748-5131 |
Practice Address - Fax: | 802-748-4237 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2018-03-23 |
Last Update Date: | 2021-11-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
390200000X | ||
VT | 042.0015266 | 208000000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
VT | 6707045 | Medicaid |