Provider Demographics
NPI:1285629410
Name:SAPPINGTON, JOSEPH B (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:B
Last Name:SAPPINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HEBRON AVE
Mailing Address - Street 2:STE 213
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2176
Mailing Address - Country:US
Mailing Address - Phone:860-633-6976
Mailing Address - Fax:860-633-7978
Practice Address - Street 1:300 HEBRON AVE
Practice Address - Street 2:STE 213
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2176
Practice Address - Country:US
Practice Address - Phone:860-633-6976
Practice Address - Fax:860-633-7978
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT017176207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1171768Medicaid
060000484Medicare ID - Type Unspecified
CT1171768Medicaid