Healthcare Provider Details

I. General information

NPI: 1962558502
Provider Name (Legal Business Name): VERMONT PAIN MANAGEMENT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KENNEDY DR STE U1
SOUTH BURLINGTON VT
05403-7166
US

IV. Provider business mailing address

1 KENNEDY DR STE U1
SOUTH BURLINGTON VT
05403-7166
US

V. Phone/Fax

Practice location:
  • Phone: 802-861-6100
  • Fax: 802-861-6101
Mailing address:
  • Phone: 802-861-6100
  • Fax: 802-861-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number032-0000427
License Number StateVT

VIII. Authorized Official

Name: EVAN MUSMAN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 802-861-6100