Healthcare Provider Details

I. General information

NPI: 1043286594
Provider Name (Legal Business Name): JOSEPH L BROCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 GRANGER RD SUITE 2
BARRE VT
05641-5344
US

IV. Provider business mailing address

PO BOX 547 ATT: CVMC FINANCE DEPT
BARRE VT
05641-0547
US

V. Phone/Fax

Practice location:
  • Phone: 802-225-5810
  • Fax: 802-371-4821
Mailing address:
  • Phone: 802-225-5810
  • Fax: 802-371-4821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301047460
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number042.0011623
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: