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General NPI Number Information
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NPI Number | 1265901938
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Entity Type | Organization
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Legal Business Name | GREEN MOUNTAIN PRIMARY CARE PLC
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Dates
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Enumeration Date | 11/25/2018
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Last Update Date | 09/19/2021
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Provider Practice Location Address
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Address Line | 102A COURT ST STE A
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City | MIDDLEBURY
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State | VT
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Zip | 05753-1455
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Country | US
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Telephone | 802-382-0849
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Fax | 802-382-0144
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Provider Business Mailing Address
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Address Line | 1108 QUARRY RD
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City | MIDDLEBURY
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State | VT
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Zip | 05753-8951
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Country | US
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Telephone | 802-349-3015
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | LAURA WEYLMAN
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Credential | MD
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Telephone | 802-382-0849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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