Provider Demographics
NPI:1083602874
Name:BISSON, ROSAIRE W (PA)
Entity Type:Individual
Prefix:
First Name:ROSAIRE
Middle Name:W
Last Name:BISSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 HOLY CROSS RD
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-9719
Mailing Address - Country:US
Mailing Address - Phone:802-848-3829
Mailing Address - Fax:802-848-3829
Practice Address - Street 1:44 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:RICHFORD
Practice Address - State:VT
Practice Address - Zip Code:05476-1141
Practice Address - Country:US
Practice Address - Phone:802-255-5500
Practice Address - Fax:802-255-5509
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0550030282363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0002358Medicaid
VT00028112OtherBCBS
VTVN0879Medicare PIN
VTR98025Medicare UPIN
VT00028112OtherBCBS