Healthcare Provider Details

I. General information

NPI: 1326003906
Provider Name (Legal Business Name): LEONARD TREMBLAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CREST RD
SAINT ALBANS VT
05478-9701
US

IV. Provider business mailing address

12 CREST RD
SAINT ALBANS VT
05478-9701
US

V. Phone/Fax

Practice location:
  • Phone: 802-524-3215
  • Fax: 802-524-3523
Mailing address:
  • Phone: 802-524-3215
  • Fax: 802-524-3523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0420008433
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: