MEDICARE: MR. RICHARD GREENOUGH

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	390200000X	Student in an Organized Health Care Education/Training Program	097.0136868	VT

General Provider Information

NPI Number	:	1790631232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD GREENOUGH

Provider Business Mailing Address
First Line	:	6 POINTE DR
Second Line	:
City	:	ESSEX JCT
State	:	VT
Zip	:	05452-3945
Country	:	US
Telephone Number	:	802-999-0968
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 POINTE DR
Second Line	:
City	:	ESSEX JCT
State	:	VT
Zip	:	05452-3945
Country	:	US
Telephone Number	:	802-999-0968
Fax Number	:

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

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/19/2026

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Directions to “ MR. RICHARD GREENOUGH ” Practice Location

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