Individual
DR. HENRY SOUTHALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
439 WASHINGTON HWY, MORRISVILLE, VT 05661-8969
(802) 888-5000
(802) 888-5060
Mailing address
PO BOX 250, MORRISVILLE, VT 05661-0250
(802) 888-5000
(802) 888-5060
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
042-0005150
VT
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
042-0005150
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0004503
—
VT
01
—
11V054
MVP
VT
01
—
31V500
MVP
VT
01
—
4503
BC/BS OF VT
VT
Enumeration date
09/28/2006
Last updated
12/17/2009
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