Provider Demographics
NPI:1114946399
Name:CENTRAL VERMONT CARDIOLOGY ASSOCIATES INC.
Entity Type:Organization
Organization Name:CENTRAL VERMONT CARDIOLOGY ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-229-9524
Mailing Address - Street 1:130 FISHER RD
Mailing Address - Street 2:SUITE 2-1
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602-9516
Mailing Address - Country:US
Mailing Address - Phone:802-229-9524
Mailing Address - Fax:
Practice Address - Street 1:130 FISHER RD
Practice Address - Street 2:SUITE 2-1
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9516
Practice Address - Country:US
Practice Address - Phone:802-229-9524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTCB3446OtherRAIL ROAD MEDICARE
VT0007274Medicaid
VT0007274Medicaid