Organization
GREEN MOUNTAIN FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG DEMMING SULLIVAN (PARTNER)
(802) 485-4161
Entity
Organization
Contact information
Practice address
63 CRESCENT AVE, NORTHFIELD, VT 05663-5704
(802) 485-4161
(802) 485-4163
Mailing address
63 CRESCENT AVE, NORTHFIELD, VT 05663-5704
(802) 485-4161
(802) 485-4163
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005666
—
VT
Enumeration date
12/16/2005
Last updated
08/22/2020
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