Provider Demographics
NPI:1962558502
Name:VERMONT PAIN MANAGEMENT PC
Entity type:Organization
Organization Name:VERMONT PAIN MANAGEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:802-861-6100
Mailing Address - Street 1:1 KENNEDY DR STE U1
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7166
Mailing Address - Country:US
Mailing Address - Phone:802-861-6100
Mailing Address - Fax:802-861-6101
Practice Address - Street 1:1 KENNEDY DR STE U1
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7166
Practice Address - Country:US
Practice Address - Phone:802-861-6100
Practice Address - Fax:802-861-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT032-0000427207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT59779OtherBC BS OF VT
VT0VN3435Medicaid
DE5743OtherRR MEDICARE
VT0VN3435Medicaid