Basic Information
| Provider Information | |||||||||
| NPI: | 1154508638 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCOOL | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | RUSSELL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 289 COUNTY RD | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | VT | ||||||||
| PostalCode: | 050899000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8026747300 | ||||||||
| FaxNumber: | 8026747314 | ||||||||
| Practice Location | |||||||||
| Address1: | 289 COUNTY RD | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | VT | ||||||||
| PostalCode: | 050899000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8026747300 | ||||||||
| FaxNumber: | 8026747314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2008 | ||||||||
| LastUpdateDate: | 07/07/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 6825185-1205 | UT | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 0420012186 | VT | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.