Provider Demographics
NPI:1750721155
Name:LAMB, GINA DIAZ (MD)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:DIAZ
Last Name:LAMB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MELISSA
Other - Last Name:DIAZ-MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:140 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201
Mailing Address - Country:US
Mailing Address - Phone:802-447-5060
Mailing Address - Fax:
Practice Address - Street 1:140 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 205
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201
Practice Address - Country:US
Practice Address - Phone:802-447-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0014363208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty