Provider Demographics
NPI:1699792614
Name:BERRYHILL, BRADLEY ALAN (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:ALAN
Last Name:BERRYHILL
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 1:71 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4570
Mailing Address - Country:US
Mailing Address - Phone:802-772-4414
Mailing Address - Fax:802-772-7973
Practice Address - Street 1:275 ROUTE 30 N
Practice Address - Street 2:CASTLETON FAMILY HEALTH CENTER
Practice Address - City:BOMOSEEN
Practice Address - State:VT
Practice Address - Zip Code:05732-9647
Practice Address - Country:US
Practice Address - Phone:802-468-5641
Practice Address - Fax:802-468-2923
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420010165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03588158Medicaid
VTOVN2516Medicaid
VTOVN2516Medicaid
VTVN251605Medicare PIN
VTVN2516Medicare PIN