Healthcare Provider Details

I. General information

NPI: 1801995204
Provider Name (Legal Business Name): VERMONT RADIOLOGISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 HOSPITAL DR
ST JOHNSBURY VT
05819-9210
US

IV. Provider business mailing address

PO BOX 986520 DEPARTMENT 380
BOSTON MA
02298-6520
US

V. Phone/Fax

Practice location:
  • Phone: 802-748-7567
  • Fax:
Mailing address:
  • Phone: 207-784-2554
  • Fax: 207-777-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT SMITH
Title or Position: PRESIDENT
Credential: MD
Phone: 802-748-3638