1619276938 NPI number — RESONANT MEDICINE

Table of content: (NPI 1619276938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619276938 NPI number — RESONANT MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESONANT MEDICINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619276938
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 S MAIN ST
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
RANDOLPH
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05060-1363
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-728-9600
Provider Business Mailing Address Fax Number:
888-283-8349

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
RANDOLPH
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05060-1363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-728-9600
Provider Business Practice Location Address Fax Number:
888-283-8349
Provider Enumeration Date:
03/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HOLLIS
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
802-728-9600

Provider Taxonomy Codes

  • Taxonomy code: 175F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com