Provider Demographics
NPI:1235182247
Name:BRISTOL INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:BRISTOL INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, MED DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MULHOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-453-7422
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VT
Mailing Address - Zip Code:05443-0415
Mailing Address - Country:US
Mailing Address - Phone:802-453-7422
Mailing Address - Fax:
Practice Address - Street 1:6 PARK PL
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VT
Practice Address - Zip Code:05443-1229
Practice Address - Country:US
Practice Address - Phone:802-453-7422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT68277OtherBC BS OF VT
VT0VN3487Medicaid
VT0VN3487Medicaid
VT0VN3487Medicaid