Basic Information
| Provider Information | |||||||||
| NPI: | 1972568673 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STANCHFIELD | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 BELMONT AVE | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | BRATTLEBORO | ||||||||
| State: | VT | ||||||||
| PostalCode: | 053013498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022578360 | ||||||||
| FaxNumber: | 8022518435 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 BELMONT AVE | ||||||||
| Address2: | |||||||||
| City: | BRATTLEBORO | ||||||||
| State: | VT | ||||||||
| PostalCode: | 053017110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022583905 | ||||||||
| FaxNumber: | 8022584903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 04/13/2016 | ||||||||
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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 | 363A00000X | 055-0030830 | VT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 9000135 | 05 | VT | MEDICAID |