Healthcare Provider Details

I. General information

NPI: 1790631232
Provider Name (Legal Business Name): MR. RICHARD GREENOUGH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 HERCULES DRIVE SUITE 1A
COLCHCESTER VT
05446
US

IV. Provider business mailing address

6 POINTE DR
ESSEX JCT VT
05452-3945
US

V. Phone/Fax

Practice location:
  • Phone: 802-264-5333
  • Fax:
Mailing address:
  • Phone: 802-999-0968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number097.0136868
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: