Provider Demographics
NPI:1013938992
Name:BROWN, ABIGAIL ROSE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ABIGAIL
Middle Name:ROSE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 PLEASANT ST
Mailing Address - Street 2:STE 204
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-5881
Mailing Address - Country:US
Mailing Address - Phone:802-772-4165
Mailing Address - Fax:802-855-8489
Practice Address - Street 1:173 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4713
Practice Address - Country:US
Practice Address - Phone:802-772-4165
Practice Address - Fax:802-855-8489
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055-0031067363AM0700X
CO2244363AM0700X
VT055.0031067363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO44485018Medicaid
VT9000489Medicaid