Provider Demographics
NPI:1083749899
Name:DIGESTIVE DISEASE CENTER OF CT
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE CENTER OF CT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-756-9706
Mailing Address - Street 1:60 WESTWOOD AVE
Mailing Address - Street 2:SUITE 314
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2460
Mailing Address - Country:US
Mailing Address - Phone:203-574-3007
Mailing Address - Fax:203-573-1739
Practice Address - Street 1:60 WESTWOOD AVE
Practice Address - Street 2:SUITE 314
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2460
Practice Address - Country:US
Practice Address - Phone:203-574-3007
Practice Address - Fax:203-573-1739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB84329Medicare UPIN
CTF59860Medicare UPIN
CTB38756Medicare UPIN