Healthcare Provider Details

I. General information

NPI: 1497710065
Provider Name (Legal Business Name): GREEN MOUNTAIN ORTHOPAEDIC SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 FISHER RD BUILDING A, SUITE 2-2
BERLIN VT
05602-9516
US

IV. Provider business mailing address

130 FISHER RD BUILDING A, SUITE 2-2
BERLIN VT
05602-9516
US

V. Phone/Fax

Practice location:
  • Phone: 802-229-2663
  • Fax:
Mailing address:
  • Phone: 802-229-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6499280001
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER M. MERIAM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 802-229-2663