Provider Demographics
NPI:1114965035
Name:NORWICH ANESTHESIA ASSOCIATES, PC
Entity Type:Organization
Organization Name:NORWICH ANESTHESIA ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:D'AMATO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-823-6395
Mailing Address - Street 1:99 E RIVER DR
Mailing Address - Street 2:5TH FLOOR , ATTN CREDENTIALING
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3288
Mailing Address - Country:US
Mailing Address - Phone:860-282-4022
Mailing Address - Fax:860-282-0834
Practice Address - Street 1:326 WASHINGTON ST
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2740
Practice Address - Country:US
Practice Address - Phone:860-823-6395
Practice Address - Fax:860-823-6563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004199327OtherMEDICAID APRN GROUP #
CT004054763Medicaid
CT004054763Medicaid