Provider Demographics
NPI:1447257555
Name:VERMONT CENTER FOR CANCER MEDICINE, INC.
Entity type:Organization
Organization Name:VERMONT CENTER FOR CANCER MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PASCHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-655-7173
Mailing Address - Street 1:792 COLLEGE PKWY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-3052
Mailing Address - Country:US
Mailing Address - Phone:802-655-3400
Mailing Address - Fax:802-655-9170
Practice Address - Street 1:792 COLLEGE PKWY
Practice Address - Street 2:SUITE 207
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-3052
Practice Address - Country:US
Practice Address - Phone:802-655-3400
Practice Address - Fax:802-655-9170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN1029Medicaid
VTVN1029Medicare ID - Type Unspecified