Provider Demographics
NPI:1013082098
Name:BONAZINGA, BARTHOLOMEW J (MD, FACC)
Entity Type:Individual
Prefix:MR
First Name:BARTHOLOMEW
Middle Name:J
Last Name:BONAZINGA
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 COMMONS ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4651
Mailing Address - Country:US
Mailing Address - Phone:802-747-3600
Mailing Address - Fax:802-773-8501
Practice Address - Street 1:12 COMMONS ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701
Practice Address - Country:US
Practice Address - Phone:802-747-3600
Practice Address - Fax:802-773-8501
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0006395174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0009657Medicaid
VT926404OtherMVP
VT00005223OtherBCBS
VTINTE00048942OtherBCBS
VTINTE00048942OtherBCBS
VT0009657Medicaid
VTVN2911Medicare ID - Type UnspecifiedINTEGRATIVE CARDIOLOGY