Basic Information
| Provider Information | |||||||||
| NPI: | 1992896948 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENOIT | ||||||||
| FirstName: | NICOLAS | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44 S MAIN ST | ||||||||
| Address2: | P.O. BOX 2000 | ||||||||
| City: | RANDOLPH | ||||||||
| State: | VT | ||||||||
| PostalCode: | 050601381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027287000 | ||||||||
| FaxNumber: | 8027282613 | ||||||||
| Practice Location | |||||||||
| Address1: | 44 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RANDOLPH | ||||||||
| State: | VT | ||||||||
| PostalCode: | 050601381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027287000 | ||||||||
| FaxNumber: | 8027282613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 04/21/2010 | ||||||||
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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 | 213E00000X | N006103 | NY | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213E00000X | 056-0000180 | VT | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 0000171 | 01 | VT | MEDICARE | OTHER | 1013269 | 05 | VT | MEDICAID |