Organization
BENNINGTON FAMILY PRACTICE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELIZABETH J ELLINGSEN MHA (PRACTICE MANAGER)
(802) 447-1191
Entity
Organization
Contact information
Practice address
339 DEWEY ST, BENNINGTON, VT 05201-2253
(802) 447-1191
(802) 442-6614
Mailing address
339 DEWEY ST, BENNINGTON, VT 05201-2253
(802) 447-1191
(802) 442-6614
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
701100449
—
VT
05
—
8000038
—
VT
Enumeration date
05/08/2006
Last updated
09/29/2015
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