Organization
MOUNTAIN LAKE PLASTIC SURGERY PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN MACLENNAN MD (OWNER)
(802) 318-7787
Entity
Organization
Contact information
Practice address
105 WESTVIEW RD STE 120, COLCHESTER, VT 05446-8025
(802) 318-7787
Mailing address
105 WESTVIEW RD STE 120, COLCHESTER, VT 05446-8025
(802) 318-7787
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Enumeration date
09/17/2018
Last updated
12/13/2018
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