Organization
NORTH COUNTRY HOSPITAL & HEALTH CENTER INC
Active
Other names
North Country Dermatology Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT L FOTTER (CHIEF FINANCIAL OFFICER)
(802) 334-4111
Entity
Organization
Contact information
Practice address
189 PROUTY DR, NEWPORT, VT 05855-9326
(802) 334-4111
(802) 334-3281
Mailing address
189 PROUTY DR, NEWPORT, VT 05855-9326
(802) 334-4111
(802) 334-3281
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1008041
—
VT
05
—
30201819
—
NH
01
—
CA2318
MEDICARE RAIL ROAD
VT
01
—
NORT00029083
BLUE CROSS BLUE SHIELD
VT
Enumeration date
03/09/2007
Last updated
08/22/2020
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