Individual
MARK C. BISANZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 COLCHESTER AVE., UVM MEDICAL CENTER - DEPT. OF SURGERY/ED, BURLINGTON, VT 05401
(802) 847-2434
(802) 847-4802
Mailing address
111 COLCHESTER AVE., UVM MEDICAL CENTER - DEPT. OF SURGERY/ED, BURLINGTON, VT 05401
(802) 847-2434
(802) 847-4802
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
042-0013299
VT
207P00000X
Emergency Medicine Physician
Primary
222871
MA
207P00000X
Emergency Medicine Physician
44481
CT
207R00000X
Internal Medicine Physician
222871
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110075594A
—
MA
Enumeration date
03/22/2006
Last updated
05/22/2020
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