Provider Demographics
NPI:1396705273
Name:BRESNAHAN, H DEAN (M D)
Entity type:Individual
Prefix:
First Name:H
Middle Name:DEAN
Last Name:BRESNAHAN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 JENNY LN
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-8988
Mailing Address - Country:US
Mailing Address - Phone:802-257-1331
Mailing Address - Fax:802-254-5567
Practice Address - Street 1:53 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6630
Practice Address - Country:US
Practice Address - Phone:802-257-1331
Practice Address - Fax:802-254-5567
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTVT4607207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT4510Medicaid
VTVT4510Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO
VT4510Medicaid