NPI 1770682106 · live from the CMS NPI Registry
Miriam Blodgett Tatum, M.D.
Pediatrics, Adolescent Medicine in Derby Line, VT. National Provider Identifier 1770682106, active.
NPI record
| NPI | 1770682106 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Pediatrics, Adolescent Medicine 2080A0000X |
| Practice location | 159 Main Street, Derby Line, VT 05830 |
| Practice phone | 802-873-3009 |
| Mailing address | Po Box 970, 159 Main Street, Derby Line, VT 05830 |
| Enumerated | September 22, 2006 |
| Last updated | July 8, 2007 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Pediatrics, Adolescent Medicine primary | 2080A0000X | 042-0008370 (VT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.