Healthcare Provider Details

I. General information

NPI: 1932124286
Provider Name (Legal Business Name): MARY ARMSTRONG STANLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 WILLISTON RD SUITE 108
SOUTH BURLINGTON VT
05403-6491
US

IV. Provider business mailing address

1775 WILLISTON RD SUITE 108
SOUTH BURLINGTON VT
05403-6491
US

V. Phone/Fax

Practice location:
  • Phone: 802-497-3370
  • Fax: 802-497-0816
Mailing address:
  • Phone: 802-497-3370
  • Fax: 802-497-0816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number0420009691
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: