Healthcare Provider Details

I. General information

NPI: 1891740775
Provider Name (Legal Business Name): DIANE CHARLAND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 KNIGHT LN SUITE 10
WILLISTON VT
05495-4432
US

IV. Provider business mailing address

71 KNIGHT LN SUITE 10
WILLISTON VT
05495-4432
US

V. Phone/Fax

Practice location:
  • Phone: 802-872-7001
  • Fax:
Mailing address:
  • Phone: 802-872-7001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0420010080
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0420010080
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: