1134187784 NPI number — BRIAN F SMALE MD

Table of content: BRIAN F SMALE MD (NPI 1134187784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134187784 NPI number — BRIAN F SMALE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMALE
Provider First Name:
BRIAN
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134187784
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 WASHINGTON HIGHWAY
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
MORRISVILLE
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-888-2311
Provider Business Mailing Address Fax Number:
802-888-0031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 WASHINGTON HIGHWAY
Provider Second Line Business Practice Location Address:
HEALTH CENTER BUILDING SUITE 3
Provider Business Practice Location Address City Name:
MORRISVILLE
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-888-2311
Provider Business Practice Location Address Fax Number:
802-888-0031
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  0420010536 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1009479 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00086431 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00059227 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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