Organization
GREEN MOUNTAIN DERMATOLOGY PLLC
Active
Other names
Four Seasons Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER HALEY MD (AUTHORIZED OFFICIAL)
(561) 314-2000
Entity
Organization
Contact information
Practice address
354 MOUNTAIN VIEW DR, COLCHESTER, VT 05446-5968
(802) 864-0192
Mailing address
4700 EXCHANGE CT STE 100, BOCA RATON, FL 33431-4450
(561) 314-2000
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
01/26/2024
Last updated
10/11/2024
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