Organization
GREEN MOUNTAIN RADIOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT DALE JOHNSON M.D. (PRESIDENT)
(802) 371-4249
Entity
Organization
Contact information
Practice address
130 FISHER RD, CENTRAL VERMONT HOSPITAL, BERLIN, VT 05602-9516
(802) 371-4249
Mailing address
PO BOX 660, MORETOWN, VT 05660-0660
(802) 496-5252
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005061
—
VT
01
—
GREE00005061
BLUE SHIELD
VT
Enumeration date
09/29/2006
Last updated
08/22/2020
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