Healthcare Provider Details

I. General information

NPI: 1619989738
Provider Name (Legal Business Name): CONNECTICUT VALLEY ORTHOPAEDICS & SPORTS MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 RIDGEWOOD RD
SPRINGFIELD VT
05156-3050
US

IV. Provider business mailing address

29 RIDGEWOOD RD
SPRINGFIELD VT
05156-3050
US

V. Phone/Fax

Practice location:
  • Phone: 802-885-6373
  • Fax: 802-885-6376
Mailing address:
  • Phone: 802-885-6373
  • Fax: 802-885-6376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number StateVT

VIII. Authorized Official

Name: DAVID L MULLER
Title or Position: ADMINISTRATIVE PARTNER
Credential: M.D.
Phone: 802-885-6373