Organization
LAKESIDE PEDIATRICS, PLLC
Active
Other names
Hagan, Rinehart & Connolly Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN BERGERON (BUSINESS OFFICE MANAGER)
(802) 860-1928
Entity
Organization
Contact information
Practice address
128 LAKESIDE AVE, SUITE 115, BURLINGTON, VT 05401-4939
(802) 860-1928
(802) 860-0192
Mailing address
128 LAKESIDE AVE, SUITE 115, BURLINGTON, VT 05401-4939
(802) 860-1928
(802) 860-0192
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0420006081
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007673
—
VT
01
—
33869
MVP
VT
01
—
58026HAGA
BCBS
VT
Enumeration date
04/13/2006
Last updated
08/27/2019
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