Individual
ROYA MANSOORANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11 CREST RD, SAINT ALBANS, VT 05478-9701
(802) 527-8189
(802) 527-8187
Mailing address
600 BLAIR PARK RD STE 285, WILLISTON, VT 05495-7586
(802) 288-1140
(802) 288-1144
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
042-0009551
VT
2080A0000X
Pediatric Adolescent Medicine Physician
0420009551
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1006271
—
VT
01
—
38096
BLUE CROSS BLUE SHIELD
VT
Enumeration date
03/01/2007
Last updated
06/30/2023
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