Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | NC | |
Y | 207L00000X | Anesthesiologist | 042-0011142 | VT |
NPI | 1003891136 |
---|---|
Provider Name | Dr. Lydia S Grondin |
First Address | Burlington, VT 05401-1473 |
Second Address | Burlington, VT 05401-1473 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I34398 | (02) |