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General NPI Number Information
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NPI Number | 1619937703
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Entity Type | Individual
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Provider Name | BRYAN T LANTZ PAC
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 17 BELMONT AVE
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City | BRATTLEBORO
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State | VT
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Zip | 05301-3498
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Country | US
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Telephone | 802-251-8611
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Fax | 802-251-8419
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Provider Business Mailing Address
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Address Line | 241 ELM ST
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City | CLAREMONT
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State | NH
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Zip | 03743-2026
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Country | US
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Telephone | 603-542-7666
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Fax | 603-542-9312
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0486P
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0550030669
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License Number State | VT
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