Active NPI
Thomas Matthew Donovan
- Athletic Trainer
- Middlebury, VT
National Provider Identifier
1598539124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 104.0134001
- Practice address
- 219 S Main St
Middlebury, VT 05753-1443 - Phone
- (803) 443-4204
- NPI assigned
- Nov 14, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 104.0134001 | VT | Primary |
Addresses
Primary practice location
219 S Main St
Middlebury, VT 05753-1443
Mailing address
39 East St
Rutland, VT 05701-4128
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104.0134001 | VT | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1699920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699920000000",
"number": "1598539124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "39 EAST ST",
"city": "RUTLAND",
"state": "VT",
"postal_code": "057014128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "219 S MAIN ST",
"city": "MIDDLEBURY",
"state": "VT",
"postal_code": "057531443",
"telephone_number": "803-443-4204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DONOVAN",
"first_name": "THOMAS",
"middle_name": "MATTHEW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-11-14",
"last_updated": "2023-11-14",
"certification_date": "2023-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "VT",
"license": "104.0134001",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middlebury, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.