Provider Demographics
NPI:1083803795
Name:INTEGRATIVE CARDIOLOGY
Entity Type:Organization
Organization Name:INTEGRATIVE CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARTHOLOMEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:BONAZINGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC
Authorized Official - Phone:802-775-0100
Mailing Address - Street 1:8 COMMONS ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4651
Mailing Address - Country:US
Mailing Address - Phone:802-775-0100
Mailing Address - Fax:802-775-4135
Practice Address - Street 1:8 COMMONS ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4651
Practice Address - Country:US
Practice Address - Phone:802-775-0100
Practice Address - Fax:802-775-4135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420006395174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2911Medicaid
INTE00048942OtherBLUE CROSS
VTOVN2911Medicaid