MEDICARE: LAURI S MANSFIELD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	042-0010313	VT

General Provider Information

NPI Number	:	1366528143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURI S MANSFIELD MD

Provider Business Mailing Address
First Line	:	32 PLEASANT ST
Second Line	:
City	:	WOODSTOCK
State	:	VT
Zip	:	05091-1122
Country	:	US
Telephone Number	:	802-457-3030
Fax Number	:	802-457-2157

Provider Business Practice Location Address
First Line	:	32 PLEASANT ST
Second Line	:
City	:	WOODSTOCK
State	:	VT
Zip	:	05091-1122
Country	:	US
Telephone Number	:	802-457-3030
Fax Number	:	802-457-2157

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	07/08/2007

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