Individual
MR. GLEN CARLISLE MACKENZIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1009 DEPOT ST, MANCHESTER CENTER, VT 05255-9731
(802) 442-8649
(802) 442-8658
Mailing address
1009 DEPOT ST, MANCHESTER CENTER, VT 05255-9731
(802) 442-8649
(802) 442-8658
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
0420009174
VT
207VG0400X
Gynecology Physician
Primary
0420009174
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OVN1210
—
VT
Enumeration date
10/17/2006
Last updated
06/17/2022
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