Provider Demographics
NPI:1447208269
Name:BISSELL, WILLIAM BRADFORD HOGE (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BRADFORD HOGE
Last Name:BISSELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 137
Mailing Address - Street 2:
Mailing Address - City:BONDVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05340-0137
Mailing Address - Country:US
Mailing Address - Phone:802-297-7392
Mailing Address - Fax:
Practice Address - Street 1:405 VT ROUTE 11
Practice Address - Street 2:
Practice Address - City:BONDVILLE
Practice Address - State:VT
Practice Address - Zip Code:05340-4419
Practice Address - Country:US
Practice Address - Phone:802-297-7392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0010731207RA0401X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
I09718Medicare UPIN