Provider Demographics
NPI:1073617783
Name:GREEN MOUNTAIN PEDIATRICS PC
Entity Type:Organization
Organization Name:GREEN MOUNTAIN PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ORTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:802-442-6057
Mailing Address - Street 1:901 MAIN STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201
Mailing Address - Country:US
Mailing Address - Phone:802-442-6057
Mailing Address - Fax:802-447-1348
Practice Address - Street 1:901 MAIN STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201
Practice Address - Country:US
Practice Address - Phone:802-442-6057
Practice Address - Fax:802-447-1348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
10017477OtherCDPHP
26188OtherMVP
0427959OtherCIGNA
VT1006759Medicaid
VT33748798OtherBCBS