Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0420005258 | VT |
NPI | 1003805532 |
---|---|
Provider Name | Timothy T Cope |
First Address | Middlebury, VT 05753-8527 |
Second Address | Middlebury, VT 05753-1292 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2005 |
Last Update Date | 24/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0004610 | (05) | VT |
D03271 | (02) |