Provider Demographics
NPI:1295147924
Name:VANA, GEORGE (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:VANA
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 1:861 WILLISTON RD STE 8-1001
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-5724
Mailing Address - Country:US
Mailing Address - Phone:802-922-7613
Mailing Address - Fax:802-922-7613
Practice Address - Street 1:145 PINE HAVEN SHORES RD STE 1000-54
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7703
Practice Address - Country:US
Practice Address - Phone:802-307-9998
Practice Address - Fax:352-353-0910
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.00156112084P0804X
RILP030542084N0400X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT042.0015611OtherVERMONT STATE LICENSE
WAMD60929424OtherWA STATE LICENSE