Provider Demographics
NPI:1982016689
Name:NORTHEASTERN REPRODUCTIVE MEDICINE PLLC
Entity Type:Organization
Organization Name:NORTHEASTERN REPRODUCTIVE MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-363-4935
Mailing Address - Street 1:105 WESTVIEW ROAD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-5996
Mailing Address - Country:US
Mailing Address - Phone:802-363-4935
Mailing Address - Fax:802-985-2566
Practice Address - Street 1:105 WESTVIEW ROAD
Practice Address - Street 2:SUITE 302
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-5996
Practice Address - Country:US
Practice Address - Phone:802-363-4935
Practice Address - Fax:802-985-2566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTY100155650Medicare PIN