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General NPI Number Information
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NPI Number | 1073617783
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Entity Type | Organization
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Legal Business Name | GREEN MOUNTAIN PEDIATRICS PC
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 901 MAIN STREET SUITE 1
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City | BENNINGTON
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State | VT
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Zip | 05201
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Country | US
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Telephone | 802-442-6057
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Fax | 802-447-1348
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Provider Business Mailing Address
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Address Line | 901 MAIN STREET SUITE 1
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City | BENNINGTON
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State | VT
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Zip | 05201
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Country | US
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Telephone | 802-442-6057
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Fax | 802-447-1348
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Authorized Official
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Title or Position | PRESIDENT DIRECTOR
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Name | DR. JUDY K ORTON
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Credential | MD PA
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Telephone | 802-442-6057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | VT
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