Organization
MIDDLEBURY RADIOLOGISTS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN M. KOLLER M.D. (MANAGING PARTNER)
(802) 388-8851
Entity
Organization
Contact information
Practice address
115 PORTER DR, MIDDLEBURY, VT 05753-8423
(802) 388-8851
(802) 388-8821
Mailing address
1119 BASIN HARBOR RD, BRIDPORT, VT 05734-9570
(802) 388-8851
(802) 388-8821
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0VN1598
—
VT
01
—
29573
BLUE CROSS BLUE SHIELD
VT
Enumeration date
08/31/2006
Last updated
11/05/2015
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