Provider Demographics
NPI:1083859649
Name:DIVINAGRACIA, THOMAS V (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:V
Last Name:DIVINAGRACIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SEYMOUR ST.
Mailing Address - Street 2:SUITE 409
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106
Mailing Address - Country:US
Mailing Address - Phone:860-522-4158
Mailing Address - Fax:860-524-2652
Practice Address - Street 1:85 SEYMOUR ST.
Practice Address - Street 2:SUITE 409
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-522-4158
Practice Address - Fax:860-524-2652
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0461292085R0204X, 208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT061406459OtherPRIVATE HEALTHCARE SYSTEMS
CT1083859649OtherANTHEM BCBS
CT3V3712OtherHEALTH NET
CT06-1406459OtherPIONEER
CT06-1406459OtherGREAT-WEST HEALTHCARE
CT06-1406459OtherCORVEL
CT1083859649Medicaid
CT1083859649OtherAETNA
CT46286OtherHEALTH NEW ENGLAND
CTP4028934OtherOXFORD
CT046129OtherCONNECTICARE
CT06-1406459OtherMULTIPLAN
CT508455OtherWELLCARE
CT06-1406459OtherUNITED HEALTHCARE
CT06-1406459OtherNORTHEAST HEALTH DIRECT
CT06-1406459OtherTRICARE
CT06-1406459OtherCOMMUNITY HEALTH NETWORK
CT7299062OtherCIGNA
CT1083859649OtherAETNA