Healthcare Provider Details

I. General information

NPI: 1770287815
Provider Name (Legal Business Name): MARIANNA PARADISE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

280 GRANVILLE LN
NORTH ANDOVER MA
01845-4920
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-2345
  • Fax:
Mailing address:
  • Phone: 978-204-2616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: