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General NPI Number Information
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NPI Number | 1598269565
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Entity Type | Individual
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Provider Name | KYLE MONAHAN MD
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Gender | Male
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Dates
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Enumeration Date | 03/22/2018
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Last Update Date | 05/26/2022
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Provider Practice Location Address
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Address Line | 4185 ST GEORGE RD
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City | WILLISTON
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State | VT
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Zip | 05495-7695
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Country | US
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Telephone | 802-626-4545
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Fax |
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Provider Business Mailing Address
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Address Line | 4185 ST GEORGE RD
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City | WILLISTON
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State | VT
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Zip | 05495-7695
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Country | US
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Telephone | 802-626-4545
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 060-0004762
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 042.0015843
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License Number State | VT
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