Provider Demographics
NPI:1063644391
Name:VICTOR TIRADO MD LLC
Entity Type:Organization
Organization Name:VICTOR TIRADO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:TIRADO-MONTANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-372-4731
Mailing Address - Street 1:929 SILAS DEANE HWY
Mailing Address - Street 2:2ND FLOOR WEST
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4220
Mailing Address - Country:US
Mailing Address - Phone:860-372-4731
Mailing Address - Fax:860-372-4730
Practice Address - Street 1:929 SILAS DEANE HWY
Practice Address - Street 2:2ND FLOOR WEST
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4220
Practice Address - Country:US
Practice Address - Phone:860-372-4731
Practice Address - Fax:860-372-4730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 1041C0700X
CT0429392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty