| Border Pediatrics | |
|
159 Main St Derby Line VT 05830-8754 | |
| (802) 873-3009 | |
| (802) 873-3176 |
| Full Name | Border Pediatrics |
|---|---|
| Speciality | Pediatrics - Adolescent Medicine |
| Location | 159 Main St, Derby Line, Vermont |
| Authorized Official Name and Position | Miriam Blodgett Tatum (PRESIDENT) |
| Authorized Official Contact | 8028733009 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Border Pediatrics 159 Main St Derby Line VT 05830-8754 Ph: (802) 873-3009 | Border Pediatrics 159 Main St Derby Line VT 05830-8754 Ph: (802) 873-3009 |
| NPI Number | 1750483780 |
|---|---|
| Provider Enumeration Date | 09/01/2006 |
| Last Update Date | 01/04/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750483780 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 042-0008363 (Vermont) | Secondary |
| 2080A0000X | Pediatrics - Adolescent Medicine | 042-0008370 (Vermont) | Primary |