Organization
GREEN MOUNTAIN INTERNAL MEDICINE PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBORAH CAISE (OFFICE MANAGER)
(802) 864-7080
Entity
Organization
Contact information
Practice address
28 S WILLIAMS ST, BURLINGTON, VT 05401-3486
(802) 864-7080
Mailing address
28 S WILLIAMS ST, BURLINGTON, VT 05401-3486
(802) 864-7080
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
042-0010014
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
211-49643
BLUE CROSS BLUE SHIELD
VT
05
—
OVN2388
—
VT
Enumeration date
07/27/2017
Last updated
07/21/2022
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