Provider Demographics
NPI:1639510787
Name:TELOS, LLC
Entity Type:Organization
Organization Name:TELOS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MULHERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-365-4285
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:TOWNSHEND
Mailing Address - State:VT
Mailing Address - Zip Code:05353-0308
Mailing Address - Country:US
Mailing Address - Phone:802-365-4318
Mailing Address - Fax:
Practice Address - Street 1:152 GRAFTON ROAD
Practice Address - Street 2:
Practice Address - City:TOWNSHEND
Practice Address - State:VT
Practice Address - Zip Code:05353
Practice Address - Country:US
Practice Address - Phone:802-365-4318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420012320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty