Healthcare Provider Details

I. General information

NPI: 1356971972
Provider Name (Legal Business Name): VERMONT CENTER FOR REGENERATIVE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 KNIGHT LN STE 20
WILLISTON VT
05495-4514
US

IV. Provider business mailing address

71 KNIGHT LN STE 20
WILLISTON VT
05495-4514
US

V. Phone/Fax

Practice location:
  • Phone: 802-734-9455
  • Fax: 678-574-5605
Mailing address:
  • Phone: 802-734-9455
  • Fax: 678-574-5605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REBECCA E FIELDS
Title or Position: OFFICE MANAGER
Credential:
Phone: 802-734-9455