Provider Demographics
NPI:1144241753
Name:ORTHOPAEDIC ASSOCIATES OF BRATTLEBORO
Entity Type:Organization
Organization Name:ORTHOPAEDIC ASSOCIATES OF BRATTLEBORO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-254-9441
Mailing Address - Street 1:PO BOX 656
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302-0656
Mailing Address - Country:US
Mailing Address - Phone:802-254-9441
Mailing Address - Fax:802-254-3233
Practice Address - Street 1:EXIT ONE PARK
Practice Address - Street 2:71 GSP DRIVE
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05302
Practice Address - Country:US
Practice Address - Phone:802-254-9441
Practice Address - Fax:802-254-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTORTH00004555OtherBC/VT
VT0004555Medicaid
VTORTH00004555OtherBC/VT
VTVT4555Medicare ID - Type Unspecified