Provider Demographics
NPI:1326331471
Name:CIRCULATORY CENTERS CONNECTICUT, LLC
Entity Type:Organization
Organization Name:CIRCULATORY CENTERS CONNECTICUT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CERTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-967-9220
Mailing Address - Street 1:397 CHURCHILL HUBBARD RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1375
Mailing Address - Country:US
Mailing Address - Phone:330-759-6750
Mailing Address - Fax:330-759-6755
Practice Address - Street 1:4 HUNTLEY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:OLD LYME
Practice Address - State:CT
Practice Address - Zip Code:06371-1449
Practice Address - Country:US
Practice Address - Phone:860-434-4073
Practice Address - Fax:860-434-4635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039899208D00000X
CT005169363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty