Individual provider · NPI-1

Dr. Spencer L. Blackman, MD

Family Medicine · Burlington, VT

NPI number1205914884
StatusActive
Last updated in NPPESAug 18, 2026

Details

NPI
1205914884
Entity type
Individual (NPI-1)
Name
Dr. Spencer L. Blackman
Credential
MD
Sex
Male
Sole proprietor
Yes
Enumeration date
Nov 1, 2006
Certification date
Aug 18, 2026
Last updated
Aug 18, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine042.0013274VTYes
207Q00000X Family MedicineV4643TX
207Q00000X Family Medicine84995GA
207Q00000X Family Medicine2020-04415NC
207Q00000X Family Medicine296496NY
207Q00000X Family Medicine254843MA
207Q00000X Family MedicineME43528FL
207Q00000X Family Medicinea88542CA

Practice location

462 Shelburne Rd Ste 102
Burlington, VT 05401-6947

Phone 802-227-4417 · Fax 802-227-6897

Mailing address

462 Shelburne Rd Ste 102
Burlington, VT 05401-6947

Phone 802-227-4417 · Fax 802-227-6897

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