Tatum, Miriam Blodgett

Tatum, Miriam Blodgett is an individual health care provider with primary practice located at 159 Main Street , Derby Line VT 05830. She recently has only one registered license in Allopathic & Osteopathic Physicians / Adolescent Medicine, which is considered as her primary health care specialty. Tatum, Miriam Blodgett can be contacted via phone (802) 873-3009.

Contact Information

Primary practice address
159 Main Street Derby Line VT 05830
Phone: (802) 873-3009
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adolescent Medicine 2080A0000X 042-0008370 Vermont

Profile Details

NPI number 1770682106
LBN Legal business name Tatum, Miriam Blodgett
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 22nd, 2006
Last updated Jul 8th, 2007 - about 19 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 1770682106 NPPES
Vermont Other 042-0008370 STATE LICENSE NUMBER
Vermont MEDICAID 0VN0264 STATE LICENSE NUMBER

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