Healthcare Provider Details

I. General information

NPI: 1730421538
Provider Name (Legal Business Name): AARON WALLACE BURLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 MAIN ST
ESSEX JUNCTION VT
05452-3207
US

IV. Provider business mailing address

89 MAIN ST
ESSEX JUNCTION VT
05452-3207
US

V. Phone/Fax

Practice location:
  • Phone: 802-879-6556
  • Fax: 802-872-8021
Mailing address:
  • Phone: 802-879-6556
  • Fax: 802-872-8021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0420013378
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: