Healthcare Provider Details

I. General information

NPI: 1043139629
Provider Name (Legal Business Name): GREEN MOUNTAIN ANESTHESIA GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 HERCULES DR STE 2
COLCHESTER VT
05446-8112
US

IV. Provider business mailing address

525 HERCULES DR STE 2
COLCHESTER VT
05446-8112
US

V. Phone/Fax

Practice location:
  • Phone: 802-861-4206
  • Fax:
Mailing address:
  • Phone: 802-861-4206
  • Fax: 802-338-9390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ERICA DUMONT
Title or Position: BUSINESS MANAGER
Credential:
Phone: 802-861-4206