Provider Demographics
NPI:1104884824
Name:AFFILIATES IN OBSTETRICAL & GYNECOLOGICAL CARE INC
Entity type:Organization
Organization Name:AFFILIATES IN OBSTETRICAL & GYNECOLOGICAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CLIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-658-0505
Mailing Address - Street 1:96 COLCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1417
Mailing Address - Country:US
Mailing Address - Phone:802-658-0505
Mailing Address - Fax:
Practice Address - Street 1:96 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1417
Practice Address - Country:US
Practice Address - Phone:802-658-0505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0004930Medicaid
VTCM9478OtherRAIL ROAD MEDICARE
VT0004930Medicaid