Provider Demographics
NPI:1841587839
Name:RODRIGUEZ, BRIAN L (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:RODRIGUEZ
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 1:130 FISHER RD., STE. #3-1
Mailing Address - Street 2:FAHC-BERLIN FAMILY PRACTICE
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602
Mailing Address - Country:US
Mailing Address - Phone:802-225-7000
Mailing Address - Fax:802-225-7103
Practice Address - Street 1:130 FISHER RD., STE. #3-1
Practice Address - Street 2:FAHC-BERLIN FAMILY PRACTICE
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602
Practice Address - Country:US
Practice Address - Phone:802-225-7000
Practice Address - Fax:802-225-7103
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEEC111064207Q00000X
VT042.0012938207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine