Mackenzie, Glen Carlisle

Mackenzie, Glen Carlisle is an sole proprietor health care provider with primary practice located at 1009 Depot St , Manchester Center VT 05255-9731. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, Allopathic & Osteopathic Physicians / Gynecology. Allopathic & Osteopathic Physicians / Gynecology is his primary health care specialty. Mackenzie, Glen Carlisle can be contacted via phone (802) 442-8649.

Contact Information

Primary practice address
1009 Depot St Manchester Center VT 05255-9731
Phone: (802) 442-8649
Fax: (802) 442-8658
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 0420009174 Vermont
Allopathic & Osteopathic Physicians / Gynecology 207VG0400X 0420009174 Vermont

Profile Details

NPI number 1306926704
LBN Legal business name Mackenzie, Glen Carlisle
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 17th, 2006
Last updated Jun 17th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306926704 NPPES
Vermont MEDICAID OVN1210

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