Provider Demographics
NPI:1174668396
Name:MUNSON, RICHARD G (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:G
Last Name:MUNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SOUTH MAIN STREET
Mailing Address - Street 2:VERMONT STATE HOSPITAL
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05671-2501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 SOUTH MAIN STREET
Practice Address - Street 2:VERMONT STATE HOSPITAL
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05671-2501
Practice Address - Country:US
Practice Address - Phone:802-241-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT04200082272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN0259Medicaid
VTOVN0259Medicaid