Healthcare Provider Details

I. General information

NPI: 1588593479
Provider Name (Legal Business Name): GREEN MOUNTAIN WOMEN'S IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 INTERSTATE CORPORATE CTR STE 102
WILLISTON VT
05495-7174
US

IV. Provider business mailing address

100 INTERSTATE CORPORATE CTR STE 102
WILLISTON VT
05495-7174
US

V. Phone/Fax

Practice location:
  • Phone: 802-923-9219
  • Fax:
Mailing address:
  • Phone: 802-923-9219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES E EAST
Title or Position: MANAGER
Credential: MD
Phone: 802-923-9219