Provider Demographics
NPI:1801881610
Name:BAHNSON, DAVID HASTINGS (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HASTINGS
Last Name:BAHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ALBERT CREE DR
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4601
Mailing Address - Country:US
Mailing Address - Phone:802-775-2937
Mailing Address - Fax:802-773-0934
Practice Address - Street 1:3 ALBERT CREE DR
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4601
Practice Address - Country:US
Practice Address - Phone:802-775-2937
Practice Address - Fax:802-773-0934
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420007062174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00006019OtherBCBS
VT18182OtherMOHAWK VALLEY PHYSICIAN
UT42585OtherCIGNA
4971OtherCAPITAL DIST PHY HEALTH P
VT0006019Medicaid
UT42585OtherCIGNA
VTD86778Medicare UPIN