Provider Demographics
NPI:1265443519
Name:LOSCALZO, CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:LOSCALZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 WEPAWAUG RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2424
Mailing Address - Country:US
Mailing Address - Phone:203-389-6402
Mailing Address - Fax:
Practice Address - Street 1:40 TEMPLE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2715
Practice Address - Country:US
Practice Address - Phone:203-789-2272
Practice Address - Fax:203-865-8614
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030648207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060019530OtherMEDICARE RAILROAD PIN
CT001306481Medicaid
CT060019530OtherMEDICARE RAILROAD PIN
CT060000995Medicare ID - Type Unspecified
CT060001776Medicare PIN
CTE58048Medicare UPIN
CT060019530Medicare PIN