Provider Demographics
NPI:1053347708
Name:BAMFORD, JENNIFER BRENNAN (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BRENNAN
Last Name:BAMFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:130 FISHER RD.
Mailing Address - Street 2:UVM MEDICAL CENTER - FM/BERLIN
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602
Mailing Address - Country:US
Mailing Address - Phone:802-847-7000
Mailing Address - Fax:802-847-7103
Practice Address - Street 1:130 FISHER RD.
Practice Address - Street 2:UVM MEDICAL CENTER - FM/BERLIN
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602
Practice Address - Country:US
Practice Address - Phone:802-847-7000
Practice Address - Fax:802-847-7103
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071873L207Q00000X
VT042.0013111207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001809031Medicaid
PA039275OtherJOHNS HOPKINS
MD608838OtherCAREFIRST MD BCBS
PA01108303OtherCAPITAL BLUE CROSS-WMG
PA68898OtherGEISINGER
PA1142446OtherAMERIHEALTH MERCY-WMG
PA110552OtherUNISON-WMG
PA670422OtherHIGHMARK BLUE SHIELD
PA7524489OtherAETNA
PA284433OtherMAMSI-WMG
PAP002883OtherGATEWAY-WMG
PAG77597Medicare UPIN
PA040293-FLTMedicare PIN
PA68898OtherGEISINGER