Individual
DR. GREGORY CONNOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
042-0011956
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1017604
—
VT
Enumeration date
07/12/2007
Last updated
10/04/2013
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