# LAKESIDE PEDIATRICS, PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Hagan, Rinehart & Connolly Pediatrics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104880426
- **Authorized official:** LYNN BERGERON (BUSINESS OFFICE MANAGER)
- **Authorized official phone:** (802) 860-1928

## Contact information

- **Practice address:** 128 LAKESIDE AVE, SUITE 115, BURLINGTON, VT 05401-4939
- **Practice address phone:** (802) 860-1928
- **Practice address fax:** (802) 860-0192
- **Mailing address:** 128 LAKESIDE AVE, SUITE 115, BURLINGTON, VT 05401-4939
- **Mailing address phone:** (802) 860-1928
- **Mailing address fax:** (802) 860-0192

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | 0420006081 | VT | Yes |

## Other

- **Enumeration date:** 04/13/2006
- **Last updated:** 08/27/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1007673 | — | VT |
| 01 | — | 33869 | MVP | VT |
| 01 | — | 58026HAGA | BCBS | VT |