Individual
LARRY ALLEN SISSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
41 MEDICAL VILLAGE DR, NEWPORT, VT 05855-9835
(802) 334-3500
(802) 334-3502
Mailing address
41 MEDICAL VILLAGE DR, NEWPORT, VT 05855-9835
(802) 334-3500
(802) 334-3502
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0420007770
VT
208600000X
Surgery Physician
25436020
WI
208600000X
Surgery Physician
8024
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009260
—
VT
01
—
030329674
CHAMPUS/CHAMPVA
VT
01
—
2754
BLUE CROSS/BLUE SHIELD
VT
01
—
350793
MVP
VT
01
—
80941
CIGNA
VT
Enumeration date
08/26/2005
Last updated
06/17/2011
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