Organization
GREEN MOUNTAIN PLASTIC AND RECONSTRUCTIVE SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD R LAUB JR. MD (PHYSICIAN)
(802) 598-9619
Entity
Organization
Contact information
Practice address
354 MOUNTAIN VIEW DR STE 300, COLCHESTER, VT 05446-5988
(802) 864-0192
(802) 860-4919
Mailing address
354 MOUNTAIN VIEW DR STE 300, COLCHESTER, VT 05446-5988
(802) 864-0192
(802) 860-4919
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
42-0008887
VT
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
42-0008887
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OVN1072
—
VT
Enumeration date
11/06/2017
Last updated
11/06/2017
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