Healthcare Provider Details

I. General information

NPI: 1770419020
Provider Name (Legal Business Name): BRATTLEBORO MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 MAIN STREET
PUTNEY VT
05346-8318
US

IV. Provider business mailing address

17 BELMONT AVENUE
BRATTLEBORO VT
05301-7601
US

V. Phone/Fax

Practice location:
  • Phone: 802-387-5581
  • Fax: 802-387-6694
Mailing address:
  • Phone: 802-387-5581
  • Fax: 802-387-6694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY FROST
Title or Position: INTERIM ASST CONTROLLER
Credential:
Phone: 802-257-8249