Provider Demographics
NPI:1942628847
Name:EVERETT, BRENDAN T (MD)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:T
Last Name:EVERETT
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 1:195 HOSPITAL LOOP STE 7
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602-8495
Mailing Address - Country:US
Mailing Address - Phone:802-229-9144
Mailing Address - Fax:
Practice Address - Street 1:195 HOSPITAL LOOP STE 7
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-8495
Practice Address - Country:US
Practice Address - Phone:802-229-9144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-29
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0013752207R00000X
VT042.0013752207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine