Healthcare Provider Details

I. General information

NPI: 1215852603
Provider Name (Legal Business Name): GREEN MOUNTAIN BREAST CARE CENTER PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 S MAIN ST STE 1B
STOWE VT
05672-4679
US

IV. Provider business mailing address

2049 BATTLE ROW RD
HYDE PARK VT
05655-9645
US

V. Phone/Fax

Practice location:
  • Phone: 802-441-5249
  • Fax:
Mailing address:
  • Phone: 802-441-5249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SARAH WATERMAN
Title or Position: FOUNDER
Credential: MD
Phone: 802-441-5249