Provider Demographics
NPI:1184728461
Name:KNIFFIN, FRED W (MD)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:W
Last Name:KNIFFIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:115 PORTER DRIVE
Mailing Address - Street 2:40 SUSAN SPITZNER FINANCE DEPT
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753
Mailing Address - Country:US
Mailing Address - Phone:802-388-5607
Mailing Address - Fax:802-388-5654
Practice Address - Street 1:115 PORTER DRIVE
Practice Address - Street 2:PORTER HOSPITAL
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753
Practice Address - Country:US
Practice Address - Phone:802-388-4001
Practice Address - Fax:802-388-5612
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT0420008090207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT58841OtherBCBS
VT360723OtherMVP VT MGD CARE
VT1008926Medicaid
VT58841OtherBCBS
VT1008926Medicaid