Individual
PREMA R MENON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
111 COLCHESTER AVE, PULMONARY AND CRITICAL CARE DIVISION FAHC, BURLINGTON, VT 05405-3421
(802) 847-1558
(802) 847-2444
Mailing address
89 BEAUMONT AVE, GIVEN D208D, BURLINGTON, VT 05405-1742
(802) 656-3525
(802) 656-3526
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
0420012263
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200872260A
—
IN
Enumeration date
06/18/2007
Last updated
01/05/2015
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