BORDER PEDIATRICS (NPI# 1750483780) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750483780 |
| Entity Type | Organization |
| Organization Name | BORDER PEDIATRICS |
| Other Organization Name | BORDER HEALTH CENTER |
| Practice Address |
159 Main St Derby Line VT 05830-8754 |
| Practice Telephone | 8028733009 |
| Practice Fax Number | 8028733176 |
| Mailing Telephone | 8028733009 |
| Mailing Fax Number | 8028733176 |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2013-01-04 |
| Authorized Official Name | DR. MIRIAM BLODGETT TATUM (PRESIDENT) |
| Authorized Official Telephone | 8028733009 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 042-0008363 | VT | Allopathic & Osteopathic Physicians |
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
042-0008370 | VT | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Border Health Center | Former Legal Business Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Vermont Business Registrations | BORDER PEDIATRICS | 159 Main Street, Derby Line, VT 05830 |
| Vermont Business Registrations | BORDER PEDIATRICS, PLLC | 159 Main Street, Derby Line, VT 05830 |
| Street Address |
159 MAIN ST |
| City | DERBY LINE |
| State | VT |
| Zip Code | 05830-8754 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306301817 | Briana Bonnell | Specialist/Technologist | 347 Whittier Rd, Derby Line, VT 05830 | 2019-02-08 |
| 1669549150 | Browns Drug Store | Pharmacy | 40 Main, Derby Line, VT 05830 | 2006-11-29 |
| 1770682106 | Miriam Blodgett Tatum | Pediatrics | 159 Main Street, Derby Line, VT 05830 | 2006-09-22 |
| 1518078666 | Vermont Catholic Charities, Inc. | Custodial Care Facility | 47 Herrick Road, Derby Line, VT 05830-8759 | 2006-08-31 |
| 1184999831 | Emily Lyn Jankowski | Counselor | 907 Elm St, Derby Line, VT 05830-8881 | 2012-03-14 |
| 1679515597 | Roland Norman Roy | Pharmacist | 40 Main St, Derby Line, VT 05830-9203 | 2006-06-12 |
| 1265477012 | Derby Line Ambulance | Ambulance | 67 Beech St, Derby Line, VT 05830-9302 | 2006-06-17 |
| 1386255925 | Myra Gene Ann Degre | Physical Therapist | 85 Beach St, Derby Line, VT 05830-9302 | 2020-08-16 |
| 1023284502 | Laura Leigh Lawson | Counselor | 10 Corkins St, Derby Line, VT 05830-9305 | 2008-05-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306301817 | Briana Bonnell | Specialist/Technologist | 347 Whittier Rd, Derby Line, VT 05830 | 2019-02-08 |
| 1184999831 | Emily Lyn Jankowski | Counselor | 907 Elm St, Derby Line, VT 05830-8881 | 2012-03-14 |
| 1023284502 | Laura Leigh Lawson | Counselor | 10 Corkins St, Derby Line, VT 05830-9305 | 2008-05-05 |
| 1669549150 | Browns Drug Store | Pharmacy | 40 Main, Derby Line, VT 05830 | 2006-11-29 |
| 1770682106 | Miriam Blodgett Tatum | Pediatrics | 159 Main Street, Derby Line, VT 05830 | 2006-09-22 |
| 1518078666 | Vermont Catholic Charities, Inc. | Custodial Care Facility | 47 Herrick Road, Derby Line, VT 05830-8759 | 2006-08-31 |
| 1265477012 | Derby Line Ambulance | Ambulance | 67 Beech St, Derby Line, VT 05830-9302 | 2006-06-17 |
| 1386255925 | Myra Gene Ann Degre | Physical Therapist | 85 Beach St, Derby Line, VT 05830-9302 | 2020-08-16 |
| 1679515597 | Roland Norman Roy | Pharmacist | 40 Main St, Derby Line, VT 05830-9203 | 2006-06-12 |
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770682106 | Miriam Blodgett Tatum | Pediatrics | 159 Main Street, Derby Line, VT 05830 | 2006-09-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083759708 | Frederick C Holmes | Pediatrics | 11 Crest Rd, Saint Albans, VT 05478-9701 | 2007-02-20 |
| 1053369017 | Harold Taylor Yates Jr. | Pediatrics | 91 S Main St, St Albans, VT 05478-2209 | 2006-05-04 |
| 1881253714 | Gussie Belisle | Pediatrics | 44 Collins Dr Ste 202, Middlebury, VT 05753-8502 | 2019-06-13 |
| 1699335547 | Dayna Stimson | Pediatrics | 44 Collins Dr Ste 202, Middlebury, VT 05753-8502 | 2019-06-13 |
| 1477935716 | Upper Valley Pediatrics, Pllc | Pediatrics | 331 Upper Pln, Bradford, VT 05033-9207 | 2015-06-23 |
| 1366641086 | Gregory Connolly | Pediatrics | 128 Lakeside Ave, Suite 115, Burlington, VT 05401-4939 | 2007-07-12 |
| 1336278092 | Mousetrap Pediatrics PC | Pediatrics | 11 Crest Rd, Saint Albans, VT 05478-9701 | 2007-03-05 |
| 1215065032 | Deanne Haag | Pediatrics | 11 Crest Rd, Saint Albans, VT 05478-9701 | 2007-03-01 |
| 1275661092 | Heidi Zvolensky | Pediatrics | 11 Crest Rd, Saint Albans, VT 05478-9701 | 2007-03-01 |
| 1073641890 | Roya Mansoorani | Pediatrics | 11 Crest Rd, Saint Albans, VT 05478-9701 | 2007-03-01 |
| Find all providers with the same taxonomy | ||||
| City | DERBY LINE |
| Zip Code | 05830 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.