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General NPI Number Information
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NPI Number | 1215852603
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Entity Type | Organization
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Legal Business Name | GREEN MOUNTAIN BREAST CARE CENTER PLC
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Dates
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Enumeration Date | 08/12/2026
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Last Update Date | 08/12/2026
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Provider Practice Location Address
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Address Line | 166 S MAIN ST STE 1B
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City | STOWE
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State | VT
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Zip | 05672-4679
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Country | US
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Telephone | 802-441-5249
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Fax |
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Provider Business Mailing Address
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Address Line | 2049 BATTLE ROW RD
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City | HYDE PARK
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State | VT
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Zip | 05655-9645
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Country | US
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Telephone | 802-441-5249
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | DR. SARAH WATERMAN
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Credential | MD
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Telephone | 802-441-5249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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