Provider Demographics
NPI:1134187784
Name:SMALE, BRIAN F (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:F
Last Name:SMALE
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 1:530 WASHINGTON HIGHWAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661
Mailing Address - Country:US
Mailing Address - Phone:802-888-2311
Mailing Address - Fax:802-888-0031
Practice Address - Street 1:530 WASHINGTON HIGHWAY
Practice Address - Street 2:HEALTH CENTER BUILDING SUITE 3
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661
Practice Address - Country:US
Practice Address - Phone:802-888-2311
Practice Address - Fax:802-888-0031
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420010536208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009479Medicaid
P00086431OtherRAILROAD MEDICARE
VT00059227OtherBLUE CROSS BLUE SHIELD
P00086431OtherRAILROAD MEDICARE
B66612Medicare UPIN