Provider Demographics
NPI:1225702947
Name:CONNECTICUT MEDICAL SPECIALISTS PC
Entity Type:Organization
Organization Name:CONNECTICUT MEDICAL SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:HIRENKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ITALIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-557-8950
Mailing Address - Street 1:133 ROLLINS AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 LAFAYETTE BLVD
Practice Address - Street 2:SUITE 1100
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604
Practice Address - Country:US
Practice Address - Phone:800-557-8950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center