Glen Mackenzie MD PC

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

License

420009174 Issued in VT

Legal business name

GLEN MACKENZIE MD PC

Practice address

1009 Depot St
Manchester Center, VT 05255-9731

Phone

(802) 442-8649

Fax

(802) 442-8658

NPI assigned

Apr 20, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Glen Carlisle Mackenzie, M.D.NPI 1306926704

Title

President

Phone

(802) 442-8649

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VT

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Glen Carlisle Mackenzie, MD

  • Gynecology Physician
  • Manchester Center, VT
  • NPI 1306926704
  Medicare reassignment NPD Authorized official
• Donna M Miller, MD

  • Pediatrics Physician
  • Manchester Center, VT
  • NPI 1457431843
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1461110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655424000000",
    "number": "1467806067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1009 DEPOT ST",
            "city": "MANCHESTER CENTER",
            "state": "VT",
            "postal_code": "052559731",
            "telephone_number": "802-442-8649",
            "fax_number": "802-442-8658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 DEPOT ST",
            "city": "MANCHESTER CENTER",
            "state": "VT",
            "postal_code": "052559731",
            "telephone_number": "802-442-8649",
            "fax_number": "802-442-8658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN MACKENZIE MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-20",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-17",
        "status": "A",
        "authorized_official_last_name": "MACKENZIE",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "CARLISLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "802-442-8649",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "VT",
            "license": "420009174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OVN1210",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carlie Michelle Felion, FNP, PMHNP
• Susan Flanagan, CCC/SLP
• Pamela Louise Fletcher Maine, PT
• Elizabeth Ann Fredland, LICSW
• Robert Giering, MD
• William Goodwin, ARNP
• Danielle Nicole Granaroli, MT
• Lynn Grieger, RD, CDE
• Verlinda W Griffin
• Nicholas Maguire Guy, DMD

• Gynecology Physician in Manchester Center, VT
• Providers in Manchester Center, VT by specialty
• Gynecology Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.