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General NPI Number Information
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NPI Number | 1316085814
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Entity Type | Organization
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Legal Business Name | MID VERMONT PATHOLOGY PC
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 07/30/2019
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Provider Practice Location Address
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Address Line | 160 ALLEN STREET RUTLAND REGIONAL MEDICAL CENTER
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City | RUTLAND
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State | VT
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Zip | 05701
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Country | US
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Telephone | 802-747-1786
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Fax | 802-747-6525
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Provider Business Mailing Address
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Address Line | 160 ALLEN STREET RUTLAND REGIONAL MEDICAL CENTER
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City | RUTLAND
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State | VT
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Zip | 05701
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Country | US
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Telephone | 802-747-1786
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Fax | 802-747-6525
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Authorized Official
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Title or Position | DIRECTOR
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Name | TONY MASUCK
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Credential | MD
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Telephone | 802-259-3490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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