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General NPI Number Information
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NPI Number | 1205063492
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Entity Type | Individual
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Provider Name | HEATHER A LESAGE-HORTON M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/16/2009
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 21 BELMONT AVE
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City | BRATTLEBORO
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State | VT
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Zip | 05301-7110
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Country | US
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Telephone | 802-258-3905
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Fax |
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Provider Business Mailing Address
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Address Line | 600 BLAIR PARK RD STE 285
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City | WILLISTON
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State | VT
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Zip | 05495-7586
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Country | US
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Telephone | 802-288-1140
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Fax | 802-288-1140
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 1056982
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 042-0012847
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License Number State | VT
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Taxonomy #3
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 4301094661
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301094661
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License Number State | MI
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