Provider Demographics
NPI:1972517969
Name:MCSORLEY, JANET STILES (NP)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:STILES
Last Name:MCSORLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E14 STONEHEDGE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7367
Mailing Address - Country:US
Mailing Address - Phone:802-657-4189
Mailing Address - Fax:802-847-0970
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:MAIN PAVILION-LEVEL 5 VASCULAR
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-4548
Practice Address - Fax:802-847-0970
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-00145452086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009429Medicaid
NPPOOOMedicare UPIN
NP3068Medicare ID - Type Unspecified