Healthcare Provider Details

I. General information

NPI: 1245263896
Provider Name (Legal Business Name): ANDREW CARL STANLEY MD
Entity Type: Individual
Gender: Male
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 MAIN PAVILION-LEVEL 5 VASCULAR
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

1040 BEAVER CREEK RD
SHELBURNE VT
05482-6959
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-7097
  • Fax: 802-847-0970
Mailing address:
  • Phone: 802-847-7097
  • Fax: 802-847-0970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number042-0009662
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: