MEDICARE: PULMONARY INTERNISTS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RS0012X	Sleep Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1124296447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PULMONARY INTERNISTS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1517
Second Line	:
City	:	WILLISTON
State	:	VT
Zip	:	05495-1517
Country	:	US
Telephone Number	:	802-735-5927
Fax Number	:	802-878-3757

Provider Business Practice Location Address
First Line	:	139 PEARL ST
Second Line	:
City	:	ESSEX JCT
State	:	VT
Zip	:	05452-3659
Country	:	US
Telephone Number	:	802-878-4445
Fax Number	:

Authorized Official
Title or Position	:	M.D.
Name	:	STEPHEN GORMAN
Credential	:
Telephone Number	:	802-382-8880

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	07/22/2020

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