Organization
BORDER PEDIATRICS
Active
Other names
Border Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIRIAM BLODGETT TATUM M.D. (PRESIDENT)
(802) 873-3009
Entity
Organization
Contact information
Practice address
159 MAIN ST, DERBY LINE, VT 05830-8754
(802) 873-3009
(802) 873-3176
Mailing address
159 MAIN ST, DERBY LINE, VT 05830-8754
(802) 873-3009
(802) 873-3176
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
042-0008363
VT
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
042-0008370
VT
Other
Enumeration date
09/01/2006
Last updated
01/04/2013
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