Provider Demographics
NPI:1689628786
Name:ANESTHESIOLOGY ASSOCIATES OF BENNINGTON
Entity Type:Organization
Organization Name:ANESTHESIOLOGY ASSOCIATES OF BENNINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:E. MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TARAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-447-5590
Mailing Address - Street 1:PO BOX 252
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-0252
Mailing Address - Country:US
Mailing Address - Phone:800-720-1664
Mailing Address - Fax:207-753-2020
Practice Address - Street 1:100 HOSPITAL DRIVE
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-5004
Practice Address - Country:US
Practice Address - Phone:802-447-5590
Practice Address - Fax:802-440-6099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0005739Medicaid
CD9169OtherRAILROAD MEDICARE
CD9169OtherRAILROAD MEDICARE