Provider Demographics
NPI:1467498519
Name:CARDIOLOGY ASSOC OF BRISTOL PC
Entity Type:Organization
Organization Name:CARDIOLOGY ASSOC OF BRISTOL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:MASTROPOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-582-2829
Mailing Address - Street 1:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:225 NORTH MAIN STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010
Practice Address - Country:US
Practice Address - Phone:860-582-2829
Practice Address - Fax:860-584-5994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
207440OtherCONNECTICARE
0407792OtherEVERCARE MEDICARE
010020744CT01OtherANTHEM BC
2604202OtherAETNA
00120744800OtherBLUECARE FAMILY
0R1850OtherHEALTH NET
HAP029OtherOXFORD