Provider Demographics
NPI:1801099650
Name:SCOTT A VANDER VENNET MD LLC
Entity type:Organization
Organization Name:SCOTT A VANDER VENNET MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERVENNET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-736-2229
Mailing Address - Street 1:320 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-2303
Mailing Address - Country:US
Mailing Address - Phone:203-736-2229
Mailing Address - Fax:203-732-2405
Practice Address - Street 1:320 MAIN ST
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-2303
Practice Address - Country:US
Practice Address - Phone:203-736-2229
Practice Address - Fax:203-732-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037036207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03286Medicare ID - Type Unspecified
H77759Medicare UPIN