Mountain Lake Plastic Surgery PLC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

Legal business name

MOUNTAIN LAKE PLASTIC SURGERY PLC

Practice address

105 Westview Rd Ste 120
Colchester, VT 05446-8025

Phone

(802) 318-7787

NPI assigned

Sep 17, 2018

Last updated

Dec 13, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Susan Maclennan, MDNPI 1346268018

Title

Owner

Phone

(802) 318-7787

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VT

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Susan E Maclennan, MD

  • Plastic and Reconstructive Surgery Physician
  • Colchester, VT
  • NPI 1346268018
  Authorized official Same address or phone
• Alexandra Kaye, RN

  • Registered Nurse
  • Colchester, VT
  • NPI 1891323556
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1537142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544659200000",
    "number": "1699259648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 WESTVIEW RD STE 120",
            "city": "COLCHESTER",
            "state": "VT",
            "postal_code": "054468025",
            "telephone_number": "802-318-7787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 WESTVIEW RD STE 120",
            "city": "COLCHESTER",
            "state": "VT",
            "postal_code": "054468025",
            "telephone_number": "802-318-7787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN LAKE PLASTIC SURGERY PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-17",
        "last_updated": "2018-12-13",
        "status": "A",
        "authorized_official_last_name": "MACLENNAN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "802-318-7787",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Anne Moore, FNP
• Jennifer M Moore, PT
• Jessica Moore, ATC
• Elaine Morse, LCSW
• Kathy Mosman, OTA
• Mountain View ABA LLC
• Diane Irene Muhr, MS
• Moira A Mulligan, MS CCC SLP
• Allyson Murdock, M.S.
• Leah Ann Murdock, PT, DPT

• Plastic Surgery Physician in Colchester, VT
• Providers in Colchester, VT by specialty
• Plastic Surgery Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.