Organization
INTEGRATIVE CARDIOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BARTHOLOMEW J BONAZINGA M.D, F.A.C.C. (PHYSICIAN/OWNER)
(802) 775-0100
Entity
Organization
Contact information
Practice address
8 COMMONS ST, RUTLAND, VT 05701-4651
(802) 775-0100
(802) 775-4135
Mailing address
8 COMMONS ST, RUTLAND, VT 05701-4651
(802) 775-0100
(802) 775-4135
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0420006395
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
INTE00048942
BLUE CROSS
—
05
—
OVN2911
—
VT
Enumeration date
10/18/2007
Last updated
10/21/2010
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