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Organization
GREEN MOUNTAIN UROLOGY INC
Active
Organization
GREEN MOUNTAIN UROLOGY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD T GRUNERT MD (PRESIDENT)
(802) 655-4900
Entity
Organization
Contact information
Practice address
792 COLLEGE PKWY, SUITE302, COLCHESTER, VT 05446-3052
(802) 655-4900
(802) 655-5017
Mailing address
792 COLLEGE PKWY, SUITE302, COLCHESTER, VT 05446-3052
(802) 655-4900
(802) 655-5017
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
NULL
208800000X
Urology Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0VN0583
—
VT
Enumeration date
11/08/2005
Last updated
02/25/2010
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