Provider Demographics
NPI:1316000425
Name:CENTRAL CONNECTICUT CARDIOLOGISTS LLC
Entity Type:Organization
Organization Name:CENTRAL CONNECTICUT CARDIOLOGISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CIAFONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-525-1234
Mailing Address - Street 1:19 WOODLAND STREET
Mailing Address - Street 2:SUITE 47
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2372
Mailing Address - Country:US
Mailing Address - Phone:860-525-4005
Mailing Address - Fax:860-525-4839
Practice Address - Street 1:19 WOODLAND STREET
Practice Address - Street 2:SUITE 35
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2372
Practice Address - Country:US
Practice Address - Phone:860-525-1234
Practice Address - Fax:860-278-8782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
50CCTCARDCT01OtherANTHEM BCBS
C02445CTOtherANTHEM BCBS
CT004192118Medicaid
CTC15218OtherRAILROAD MEDICARE
CTC02445Medicare ID - Type Unspecified