Healthcare Provider Details

I. General information

NPI: 1609873447
Provider Name (Legal Business Name): RONALD S. MENSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 HOSPITAL DRIVE MEDICAL BUILDING
BENNINGTON VT
05201
US

IV. Provider business mailing address

340 MAIN ST SUITE 670
WORCESTER MA
01608-1604
US

V. Phone/Fax

Practice location:
  • Phone: 802-447-1536
  • Fax: 802-447-0996
Mailing address:
  • Phone: 508-754-3566
  • Fax: 508-798-8012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0420006620
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0420006620
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: