MEDICARE: BRATTLEBORO MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician
3	207RC0000X	Cardiovascular Disease Physician
4	207V00000X	Obstetrics & Gynecology Physician
5	207X00000X	Orthopaedic Surgery Physician
6	207Y00000X	Otolaryngology Physician
7	207YX0602X	Otolaryngic Allergy Physician
8	208000000X	Pediatrics Physician
9	208600000X	Surgery Physician
10	208800000X	Urology Physician
11	282N00000X	General Acute Care Hospital
12	282N00000X	General Acute Care Hospital	648	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	470011	OTHER	VT	BLUE CROSS PROVIDER #

General Provider Information

NPI Number	:	1306849708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRATTLEBORO MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	17 BELMONT AVE
Second Line	:
City	:	BRATTLEBORO
State	:	VT
Zip	:	05301-3498
Country	:	US
Telephone Number	:	802-257-0341
Fax Number	:	802-257-8834

Provider Business Practice Location Address
First Line	:	17 BELMONT AVE
Second Line	:
City	:	BRATTLEBORO
State	:	VT
Zip	:	05301-3498
Country	:	US
Telephone Number	:	802-257-0341
Fax Number	:	802-257-8834

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	REINA CHAMPNEY
Credential	:
Telephone Number	:	802-257-8203

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	03/23/2022

Similar Medicare Providers

1619937703 — MR. BRYAN T LANTZ PAC
Practice Location Address:

17 BELMONT AVE
BRATTLEBORO, VT
05301-3498

Practice Phone: 802-251-8611
Practice Fax: 802-251-8419

1376614883 — MEGHAN MARIE ARTHUR CNM
Practice Location Address:

28 BELMONT AVE
BRATTLEBORO, VT
05301-3498

Practice Phone: 802-251-9965
Practice Fax: 802-251-9972

1154484772 — DR. AIDA AVDIC MD
Practice Location Address:

17 BELMONT AVE STE 1
BRATTLEBORO, VT
05301-3498

Practice Phone: 802-257-0341
Practice Fax: 802-257-8834

1821125899 — WENDY ANNE DEMARTINO MD
Practice Location Address:

17 BELMONT AVE STE 1
BRATTLEBORO, VT
05301-3498

Practice Phone: 180-225-7820
Practice Fax: 802-257-8834

1871755876 — DR. JASON KEITH VEITH DO
Practice Location Address:

17 BELMONT AVE STE 1
BRATTLEBORO, VT
05301-3498

Practice Phone: 802-257-0341
Practice Fax: 802-257-8834

1588898027 — CORINA DUPREE TENNANT MD
Practice Location Address:

17 BELMONT AVE STE 1
BRATTLEBORO, VT
05301-3498

Practice Phone: 802-257-0341
Practice Fax: 802-257-8834

Directions to “BRATTLEBORO MEMORIAL HOSPITAL ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.