=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902938483
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VERMONT ORTHOPAEDIC IMAGING, PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 609 STOCKBRIDGE RD
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05445-9361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-425-5141
-----------------------------------------------------
Fax | 802-425-5141
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 609 STOCKBRIDGE RD
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05445-9361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-425-5141
-----------------------------------------------------
Fax | 802-425-5141
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. CHARLES N. PAPPAS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 802-425-5141
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 042-0008961
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------