Brookside Pediatrics & Adolescent Medicine Pllc

LBN: Brookside Pediatrics & Adolescent Medicine Pllc
Brookside Pediatrics & Adolescent Medicine Pllc is an health care organization with primary practice located at 194 North Street , Bennington VT 05201. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as the primary health care specialty. Brookside Pediatrics & Adolescent Medicine Pllc can be contacted via phone (802) 442-2264, or through Johnson, Theodore L via phone (802) 442-2264.

Contact Information

Primary practice address
194 North Street Bennington VT 05201
Phone: (802) 442-2264
Fax: (802) 442-2337
Website:
Map and Directions
Authorized official contact:
Name: Johnson, Theodore L Doctor of Medicine (MD)
Phone: (802) 442-2264

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X

Profile Details

NPI number 1568578656
LBN Legal business name Brookside Pediatrics & Adolescent Medicine Pllc
DBA Doing business as
Authorized official Johnson, Theodore L Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Aug 22nd, 2006
Last updated Oct 4th, 2011 - about 15 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568578656 NPPES
Vermont MEDICAID 1007123

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