Provider Demographics
NPI:1255366449
Name:BRUNDAGE, WILLIAM JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOHN
Last Name:BRUNDAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:278 BLUSH HILL ESTS
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-6004
Mailing Address - Country:US
Mailing Address - Phone:802-847-4535
Mailing Address - Fax:802-847-8198
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:WEST PAVILION-LEVEL 4
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-4535
Practice Address - Fax:802-847-8198
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology