Healthcare Provider Details

I. General information

NPI: 1760601256
Provider Name (Legal Business Name): VERMONT STATE COLLEGES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LYNDON STATE COLLEGE 1001 COLLEGE ROAD
LYNDONVILLE VT
05851
US

IV. Provider business mailing address

LYNDON STATE COLLEGE 1001 COLLEGE ROAD
LYNDONVILLE VT
05851
US

V. Phone/Fax

Practice location:
  • Phone: 802-626-6440
  • Fax: 802-626-6387
Mailing address:
  • Phone: 802-626-6440
  • Fax: 802-626-6387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT S BEAN
Title or Position: DIRECTOR ACCOUNTING SERVICES
Credential:
Phone: 802-626-6200