Provider Demographics
NPI:1386609253
Name:CHAMPLAIN VALLEY CARDIOVASCULAR ASSOCIATES, PC
Entity type:Organization
Organization Name:CHAMPLAIN VALLEY CARDIOVASCULAR ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAABE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-862-6312
Mailing Address - Street 1:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302-0084
Mailing Address - Country:US
Mailing Address - Phone:802-862-6312
Mailing Address - Fax:802-658-3984
Practice Address - Street 1:364 DORSET ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6270
Practice Address - Country:US
Practice Address - Phone:802-862-6312
Practice Address - Fax:802-658-3984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0006200Medicaid
VT6200Medicare ID - Type UnspecifiedGROUP MEDICARE PROVIDER #