Healthcare Provider Details

I. General information

NPI: 1083658058
Provider Name (Legal Business Name): LEAH TERESA VILLEMAIRE P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 MOUNTAIN VIEW DR SUITE 300
COLCHESTER VT
05446-5988
US

IV. Provider business mailing address

354 MOUNTAIN VIEW DR SUITE 300
COLCHESTER VT
05446-5988
US

V. Phone/Fax

Practice location:
  • Phone: 802-864-0192
  • Fax: 802-860-4919
Mailing address:
  • Phone: 802-864-0192
  • Fax: 802-860-4919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005-0031072
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: