Provider Demographics
NPI:1548623416
Name:VERMONT NATURAL FAMILY MEDICINE, PLC
Entity type:Organization
Organization Name:VERMONT NATURAL FAMILY MEDICINE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:802-598-2244
Mailing Address - Street 1:13 KILBURN ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4750
Mailing Address - Country:US
Mailing Address - Phone:802-238-8603
Mailing Address - Fax:
Practice Address - Street 1:13 KILBURN ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4750
Practice Address - Country:US
Practice Address - Phone:802-238-8603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0072105175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1018436Medicaid