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General NPI Number Information
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NPI Number | 1588640635
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Entity Type | Individual
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Provider Name | JOHN ROSS BROOKLYN M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/21/2005
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 368 DORSET ST STE 1
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-6236
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Country | US
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Telephone | 802-860-1441
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Fax |
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Provider Business Mailing Address
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Address Line | 617 RIVERSIDE AVE
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City | BURLINGTON
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State | VT
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Zip | 05401-1601
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Country | US
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Telephone | 802-864-6309
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0420008256
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 042-0008256
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License Number State | VT
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