Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 0420010083 | VT |
Y | 2084N0402X | Child Neurologist | 0420010083 | VT |
NPI | 1215955430 |
---|---|
Provider Name | Dr. Peter Matthias Bingham |
First Address | Burlington, VT 05490 |
Second Address | Burlington, VT 05401-1473 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 10/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E85194 | (02) | |
OVN2367 | (05) | VT |