Provider Demographics
NPI:1548266893
Name:DREW, SIMON PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:SIMON
Middle Name:PAUL
Last Name:DREW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:140 HOSPITAL DR
Mailing Address - Street 2:STE 203
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-5015
Mailing Address - Country:US
Mailing Address - Phone:802-442-3800
Mailing Address - Fax:802-447-0635
Practice Address - Street 1:140 HOSPITAL DR
Practice Address - Street 2:STE 203
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-5015
Practice Address - Country:US
Practice Address - Phone:802-442-3800
Practice Address - Fax:802-447-0635
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0010815208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010955Medicaid
VT1010955Medicaid
DR VN3493Medicare ID - Type Unspecified