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General NPI Number Information
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NPI Number | 1861781981
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Entity Type | Individual
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Provider Name | BRONWYN HAANES BRYANT MD
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Gender | Female
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Dates
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Enumeration Date | 03/29/2011
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 111 COLCHESTER AVE
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City | BURLINGTON
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State | VT
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Zip | 05401-1473
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Country | US
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Telephone | 802-847-5932
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Fax |
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Provider Business Mailing Address
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Address Line | 111 COLCHESTER AVENUE UVM MEDICAL CENTER INC.
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City | BURLINGTON
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State | VT
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Zip | 05401-1473
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Country | US
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Telephone |
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 4301106828
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 60388598
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 0420013682
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License Number State | VT
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