Alan Michael Maynard, LAT, ATC
Individual provider Active NPI Specialist · Burlington, VT
NPI 1477595452 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1477595452
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 1040000092 (VT)
- Practice address
- 213A Patrick Gymnasium
97 Spear St.
Burlington, VT 05405-0001 - Phone
- (802) 656-7678
- NPI assigned
- Jun 12, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1040000092 | VT | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 1040000092 | VT | Yes |
Addresses
Primary practice location
213A Patrick Gymnasium
97 Spear St.
Burlington, VT 05405-0001
Mailing address
42 Crystal Rd
Fairfax, VT 05454-9572
Phone (802) 656-7678
Other providers in Burlington, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.