Provider Demographics
NPI:1225060270
Name:RADIOLOGY ASSOCIATES OF BENNINGTON INC,
Entity Type:Organization
Organization Name:RADIOLOGY ASSOCIATES OF BENNINGTON INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:FODOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-881-3214
Mailing Address - Street 1:PO BOX 8002
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-8002
Mailing Address - Country:US
Mailing Address - Phone:800-927-0002
Mailing Address - Fax:603-890-0035
Practice Address - Street 1:100 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-5004
Practice Address - Country:US
Practice Address - Phone:802-442-6361
Practice Address - Fax:802-447-5108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVT4393Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER