Provider Demographics
NPI:1831206564
Name:HADDOCK, JOSEPH HOSKIN (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:HOSKIN
Last Name:HADDOCK
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 1:586 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05465
Mailing Address - Country:US
Mailing Address - Phone:802-878-8131
Mailing Address - Fax:802-879-6853
Practice Address - Street 1:586 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05465
Practice Address - Country:US
Practice Address - Phone:802-878-8131
Practice Address - Fax:802-879-6853
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420005909207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0002370OtherBCBS
VT0002370Medicaid
00V145OtherMIP
VTHAVT2370Medicare PIN
C65262Medicare UPIN