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General NPI Number Information
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NPI Number | 1336328152
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Entity Type | Organization
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Legal Business Name | STOWE CARDIOLOGY
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 10/29/2007
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Provider Practice Location Address
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Address Line | 377 CROSS RD
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City | STOWE
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State | VT
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Zip | 05672-4408
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Country | US
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Telephone | 802-253-2922
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Fax |
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Provider Business Mailing Address
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Address Line | 377 CROSS RD
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City | STOWE
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State | VT
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Zip | 05672-4408
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Country | US
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Telephone | 802-253-2922
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Fax |
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Authorized Official
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Title or Position | CHIEF ADMINISTATOR
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Name | RICHARD DAUM
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Credential | MD
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Telephone | 802-253-2922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 0420009652
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License Number State | VT
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