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General NPI Number Information
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NPI Number | 1497359103
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL SPINE OF VERMONT, PLLC
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Dates
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Enumeration Date | 11/23/2020
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 277 BLAIR PARK RD STE 110
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City | WILLISTON
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State | VT
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Zip | 05495-7885
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Country | US
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Telephone | 802-404-2004
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Fax | 888-506-2885
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Provider Business Mailing Address
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Address Line | PO BOX 1182
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City | WILLISTON
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State | VT
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Zip | 05495-1182
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Country | US
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Telephone | 802-404-2004
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Fax | 888-506-2885
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | ESTHER CABALLERO-MANRIQUE
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Credential | MD
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Telephone | 802-404-2004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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