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General NPI Number Information
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NPI Number | 1447621461
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Entity Type | Organization
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Legal Business Name | MMHC
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Dates
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Enumeration Date | 10/16/2015
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Last Update Date | 10/16/2015
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Provider Practice Location Address
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Address Line | 135 LAKE ST SUITE 1
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City | SAINT ALBANS
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State | VT
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Zip | 05478-2249
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Country | US
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Telephone | 401-624-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 135 LAKE ST SUITE 1
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City | SAINT ALBANS
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State | VT
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Zip | 05478-2249
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Country | US
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Telephone | 401-624-7500
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Fax |
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Authorized Official
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Title or Position | LAB DIRECTOR
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Name | DR. ROBERT DUWORS
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Credential | PH. D.
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Telephone | 401-624-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 47D2086818
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License Number State | VT
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