Provider Demographics
NPI:1194286245
Name:LAKESHORE HAND SURGERY PLLC
Entity type:Organization
Organization Name:LAKESHORE HAND SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:DURANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-734-8240
Mailing Address - Street 1:73 EVERBREEZE DR
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-1760
Mailing Address - Country:US
Mailing Address - Phone:802-734-8240
Mailing Address - Fax:
Practice Address - Street 1:120 ZEPHYR RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7558
Practice Address - Country:US
Practice Address - Phone:802-662-2272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-29
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1013801Medicaid