Healthcare Provider Details

I. General information

NPI: 1902938483
Provider Name (Legal Business Name): VERMONT ORTHOPAEDIC IMAGING, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 STOCKBRIDGE RD
CHARLOTTE VT
05445-9361
US

IV. Provider business mailing address

609 STOCKBRIDGE RD
CHARLOTTE VT
05445-9361
US

V. Phone/Fax

Practice location:
  • Phone: 802-425-5141
  • Fax: 802-425-5141
Mailing address:
  • Phone: 802-425-5141
  • Fax: 802-425-5141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number042-0008961
License Number StateVT

VIII. Authorized Official

Name: DR. CHARLES N. PAPPAS
Title or Position: MANAGER
Credential: M.D.
Phone: 802-425-5141