Provider Demographics
NPI:1710956552
Name:BENNINGTON CARDIOLOGY PC
Entity Type:Organization
Organization Name:BENNINGTON CARDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ROGGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-442-0800
Mailing Address - Street 1:PO BOX 946
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-0946
Mailing Address - Country:US
Mailing Address - Phone:802-442-0800
Mailing Address - Fax:802-442-0212
Practice Address - Street 1:140 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 312
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201
Practice Address - Country:US
Practice Address - Phone:802-442-0800
Practice Address - Fax:802-442-0212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420008933207RC0000X
VT04200093339207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT28634OtherBCBS
VTOVN1276Medicaid
CC5943OtherRAILROAD MEDICARE
VT28634OtherBCBS
VTVN1276Medicare ID - Type Unspecified