Healthcare Provider Details

I. General information

NPI: 1013938992
Provider Name (Legal Business Name): ABIGAIL ROSE BROWN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 S MAIN ST
RUTLAND VT
05701-4713
US

IV. Provider business mailing address

74 PLEASANT ST STE 204
NEW LONDON NH
03257-5881
US

V. Phone/Fax

Practice location:
  • Phone: 802-772-4165
  • Fax: 802-855-8489
Mailing address:
  • Phone: 802-772-4165
  • Fax: 802-855-8489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number055-0031067
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2244
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number055.0031067
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: