Provider Demographics
NPI:1386116895
Name:GOLDEN COLCHESTER PLLC
Entity type:Organization
Organization Name:GOLDEN COLCHESTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-878-1170
Mailing Address - Street 1:PO BOX 1277
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-1277
Mailing Address - Country:US
Mailing Address - Phone:802-878-1170
Mailing Address - Fax:802-872-7139
Practice Address - Street 1:416 ROOSEVELT HWY
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-5975
Practice Address - Country:US
Practice Address - Phone:802-655-4614
Practice Address - Fax:802-654-4614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental