Provider Demographics
NPI:1083612097
Name:PRIMIANO, CHARLES ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ARTHUR
Last Name:PRIMIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:STE. 821
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-545-5061
Mailing Address - Fax:860-545-3558
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:STE. 821
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-545-5061
Practice Address - Fax:860-545-3558
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT021038207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060000334Medicare ID - Type Unspecified
CTB37586Medicare UPIN