Provider Demographics
NPI:1538221502
Name:NANCY SCATTERGOOD DONAVAN MD
Entity type:Organization
Organization Name:NANCY SCATTERGOOD DONAVAN MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SCATTERGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-379-5874
Mailing Address - Street 1:2074 S STREAM RD
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-8886
Mailing Address - Country:US
Mailing Address - Phone:802-379-5874
Mailing Address - Fax:802-442-6703
Practice Address - Street 1:2074 S STREAM RD
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-8886
Practice Address - Country:US
Practice Address - Phone:802-379-5874
Practice Address - Fax:802-442-6703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420010148207Q00000X
VT1010021887363LF0000X
VT0420006890207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00049901OtherBLUE CROSS BLUE SHIELD
VT0NP2167Medicaid
VT0VN2535Medicaid
VT0005554Medicaid
VT080172102OtherRAILROAD MEDICARE
VT080066554OtherRAILROAD MEDICARE
VT00028237OtherBLUE CROSS BLUE SHIELD
VT08328OtherMVP
VT319096OtherMVP
VT08198OtherMVP
VT10053531OtherCDPHP
VT00029207OtherBLUE CROSS BLUE SHIELD
VT10002929OtherCDPHP
VT319096OtherMVP
VT080066554OtherRAILROAD MEDICARE
VTNP2167Medicare ID - Type Unspecified
VT10002929OtherCDPHP
VT080172102OtherRAILROAD MEDICARE
VTS28977Medicare UPIN