Healthcare Provider Details

I. General information

NPI: 1689628786
Provider Name (Legal Business Name): ANESTHESIOLOGY ASSOCIATES OF BENNINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL DRIVE ANESTHESIA DEPARTMENT
BENNINGTON VT
05201-5004
US

IV. Provider business mailing address

PO BOX 252
LEWISTON ME
04243-0252
US

V. Phone/Fax

Practice location:
  • Phone: 802-447-5590
  • Fax: 802-440-6099
Mailing address:
  • Phone: 800-720-1664
  • Fax: 207-753-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: E. MICHAEL TARAZI
Title or Position: PRESIDENT
Credential: MD
Phone: 802-447-5590