Organization
JONATHAN E. FENTON D.O., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN ERIC FENTON D.O., P.C. (PHYSICIAN)
(802) 859-0000
Entity
Organization
Contact information
Practice address
321 MAIN ST, SUITE C, WINOOSKI, VT 05404-1380
(802) 859-0000
(802) 859-0005
Mailing address
321 MAIN ST, SUITE C, WINOOSKI, VT 05404-1380
(802) 859-0000
(802) 859-0005
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
032-0000356
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
032-0000356
STATE LICENSE
VT
Enumeration date
03/26/2010
Last updated
07/30/2010
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