Provider Demographics
NPI:1093743361
Name:SCHIANO, CARL J (DO)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:J
Last Name:SCHIANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 OLD GRASSY HILL RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-2635
Mailing Address - Country:US
Mailing Address - Phone:203-263-3801
Mailing Address - Fax:
Practice Address - Street 1:59 RUBBER AVE
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4123
Practice Address - Country:US
Practice Address - Phone:203-723-7445
Practice Address - Fax:203-723-4794
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001005166Medicaid
CT001005166Medicaid
CTG92044Medicare UPIN