Healthcare Provider Details

I. General information

NPI: 1003891136
Provider Name (Legal Business Name): LYDIA S GRONDIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE DEPT OF ANESTHESIA WP2
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

111 COLCHESTER AVE DEPARTMENT OF ANESTHESIA WP2
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-2415
  • Fax:
Mailing address:
  • Phone: 802-847-2415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number200500565
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34391
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number042-0011142
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: