| Green Mountain Family Practice | |
|
63 Crescent Ave Northfield VT 05663-5704 | |
| (802) 485-4161 | |
| (802) 485-4163 |
| Full Name | Green Mountain Family Practice |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 63 Crescent Ave, Northfield, Vermont |
| Authorized Official Name and Position | Craig Demming Sullivan (PARTNER) |
| Authorized Official Contact | 8024854161 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Mountain Family Practice 63 Crescent Ave Northfield VT 05663-5704 Ph: (802) 485-4161 | Green Mountain Family Practice 63 Crescent Ave Northfield VT 05663-5704 Ph: (802) 485-4161 |
| NPI Number | 1194701623 |
|---|---|
| Provider Enumeration Date | 12/16/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194701623 | NPI | - | NPPES |
| 0005666 | Medicaid | VT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |