Provider Demographics
NPI:1912056292
Name:BRISTOL CARDIOVASCULAR ASSOCIATES, PC
Entity Type:Organization
Organization Name:BRISTOL CARDIOVASCULAR ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-582-3235
Mailing Address - Street 1:22 PINE ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-6948
Mailing Address - Country:US
Mailing Address - Phone:860-582-3235
Mailing Address - Fax:860-582-0692
Practice Address - Street 1:22 PINE ST
Practice Address - Street 2:SUITE 304
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-6948
Practice Address - Country:US
Practice Address - Phone:860-582-3235
Practice Address - Fax:860-582-0692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001252279Medicaid
CT001293646Medicaid
CT001359951Medicaid
CTE41712Medicare UPIN
CT0060001176Medicare ID - Type Unspecified
CT060000168Medicare ID - Type Unspecified
CT001252279Medicaid
CT001359951Medicaid
CTB38565Medicare UPIN