DR. MIRIAM BLODGETT TATUM M.D. NPI 1770682106

NPI Information

  • NPI: 1770682106
  • Provider Name: DR. MIRIAM BLODGETT TATUM, M.D.
  • Classification: Pediatrics - 2080A0000X
  • Specialization: Adolescent Medicine
  • Entity Type: Individual
  • Address: 159 MAIN STREET
    DERBY LINE, VT
    ZIP 05830
  • Phone: (802) 873-3009

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NPI Details

DR. Miriam Blodgett Tatum, M.D. is an adolescent medicine pediatrics in Derby Line, VT. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. DR. Miriam Blodgett Tatum, M.D. NPI is 1770682106. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

159 MAIN STREET
DERBY LINE, VT
ZIP 05830
Phone: (802) 873-3009

The enumeration date for this NPI number is 9/22/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12080A0000XPediatricsAdolescent Medicine042-0008370VERMONTYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1042-0008370OTHERVERMONTSTATE LICENSE NUMBER
2VN0264MEDICARE ID-TYPE UNSPECIFIEDVERMONT
3E13695MEDICARE UPINVERMONT
40VN0264MEDICAIDVERMONT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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