=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114946399
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL VERMONT CARDIOLOGY ASSOCIATES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2006
-----------------------------------------------------
Last Update Date | 01/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 FISHER RD SUITE 2-1
-----------------------------------------------------
City | BERLIN
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05602-9516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-229-9524
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 130 FISHER RD SUITE 2-1
-----------------------------------------------------
City | BERLIN
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05602-9516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-229-9524
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GREGORY J. MACDONALD
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 802-229-9524
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------