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General NPI Number Information
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NPI Number | 1427255538
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Entity Type | Organization
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Legal Business Name | GREEN MOUNTAIN NEUROLOGY, INC
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 02/25/2016
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Provider Practice Location Address
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Address Line | 777 NORTH ST SUITE 205
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City | PITTSFIELD
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State | MA
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Zip | 01201-4147
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Country | US
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Telephone | 413-395-7517
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Fax | 413-395-7518
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Provider Business Mailing Address
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Address Line | 777 NORTH ST SUITE 205
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City | PITTSFIELD
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State | MA
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Zip | 01201-4147
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Country | US
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Telephone | 413-395-7517
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Fax | 413-395-7518
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALEXANDER S KLOMAN
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Credential | MD
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Telephone | 413-395-7517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | 71916
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 71916
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License Number State | MA
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