Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 056-0000174 | VT |
NPI | 1194758557 |
---|---|
Provider Name | Dr. Stephen John Merena |
First Address | South Burlington, VT 05403-4440 |
Second Address | South Burlington, VT 05403-4440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 15/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0VN2096 | (05) | VT |
48378 | BC/BS (01) | VT |
U77924 | (02) | VT |