Provider Demographics
NPI:1578715462
Name:DENIS J LAMONTAGNE, DPM
Entity Type:Organization
Organization Name:DENIS J LAMONTAGNE, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:JACQUES
Authorized Official - Last Name:LAMONTAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:802-748-1918
Mailing Address - Street 1:542 RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-1741
Mailing Address - Country:US
Mailing Address - Phone:802-748-1918
Mailing Address - Fax:802-748-1919
Practice Address - Street 1:542 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-1741
Practice Address - Country:US
Practice Address - Phone:802-748-1918
Practice Address - Fax:802-748-1919
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENIS J LAMONTAGNE, DPM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT056-0000155213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0916460001Medicare NSC