Provider Demographics
NPI:1043480460
Name:GENERAL MEDICAL PRACTICE ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:GENERAL MEDICAL PRACTICE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PREZIOSO, JR.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-628-6696
Mailing Address - Street 1:70 MERIDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3272
Mailing Address - Country:US
Mailing Address - Phone:860-628-6696
Mailing Address - Fax:
Practice Address - Street 1:70 MERIDEN AVE
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-3272
Practice Address - Country:US
Practice Address - Phone:860-628-6696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT25552207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD76991Medicare UPIN