Healthcare Provider Details

I. General information

NPI: 1821017583
Provider Name (Legal Business Name): COLLEEN MARY HORAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 FISHER RD MOB-A, SUITE 1-4
BERLIN VT
05602-9516
US

IV. Provider business mailing address

PO BOX 547 ATT: CVMC FINANCE DEPARTMENT
BARRE VT
05641-0547
US

V. Phone/Fax

Practice location:
  • Phone: 802-371-5961
  • Fax: 802-371-5960
Mailing address:
  • Phone: 802-371-5961
  • Fax: 802-371-5960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD425579
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0420012252
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: