Healthcare Provider Details

I. General information

NPI: 1386609253
Provider Name (Legal Business Name): CHAMPLAIN VALLEY CARDIOVASCULAR ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 DORSET ST SUITE 1
SOUTH BURLINGTON VT
05403-6270
US

IV. Provider business mailing address

PO BOX 84
BRATTLEBORO VT
05302-0084
US

V. Phone/Fax

Practice location:
  • Phone: 802-862-6312
  • Fax: 802-658-3984
Mailing address:
  • Phone: 802-862-6312
  • Fax: 802-658-3984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL S RAABE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 802-862-6312