Healthcare Provider Details

I. General information

NPI: 1699708164
Provider Name (Legal Business Name): MAUREEN LEE HARMON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

116 FLETCHER LN
SHELBURNE VT
05482-7594
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-3736
  • Fax: 802-847-9644
Mailing address:
  • Phone: 802-985-9530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number042-0009308
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: