Healthcare Provider Details

I. General information

NPI: 1164467676
Provider Name (Legal Business Name): BRATTTLEBORO ANESTHESIA ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 BELMONT AVE
BRATTLEBORO VT
05301-6613
US

IV. Provider business mailing address

PO BOX 910
GREENFIELD MA
01302-0910
US

V. Phone/Fax

Practice location:
  • Phone: 802-257-8220
  • Fax:
Mailing address:
  • Phone: 413-772-8500
  • Fax: 413-772-8900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY N PRAH
Title or Position: TREASURER
Credential: MD
Phone: 802-257-8220