Provider Demographics
NPI:1275784399
Name:CHARYM INTEGRAL HEALTH, LITCHFIELD LLC
Entity Type:Organization
Organization Name:CHARYM INTEGRAL HEALTH, LITCHFIELD LLC
Other - Org Name:CHARYM INTEGRAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MALYNN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:UTZINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-567-5664
Mailing Address - Street 1:174 WEST ST STE 114
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-3434
Mailing Address - Country:US
Mailing Address - Phone:860-567-5664
Mailing Address - Fax:860-567-5914
Practice Address - Street 1:174 WEST ST STE 114
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759-3434
Practice Address - Country:US
Practice Address - Phone:860-567-5664
Practice Address - Fax:860-567-5914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046605261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty