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General NPI Number Information
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NPI Number | 1083803795
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE CARDIOLOGY
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 10/21/2010
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Provider Practice Location Address
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Address Line | 8 COMMONS ST
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City | RUTLAND
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State | VT
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Zip | 05701-4651
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Country | US
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Telephone | 802-775-0100
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Fax | 802-775-4135
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Provider Business Mailing Address
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Address Line | 8 COMMONS ST
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City | RUTLAND
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State | VT
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Zip | 05701-4651
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Country | US
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Telephone | 802-775-0100
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Fax | 802-775-4135
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | BARTHOLOMEW J BONAZINGA
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Credential | M.D, F.A.C.C.
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Telephone | 802-775-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0420006395
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License Number State | VT
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