Provider Demographics
NPI:1396867958
Name:PEDIATRIC CARE ASSOCIATES OF CONNECTICUT
Entity Type:Organization
Organization Name:PEDIATRIC CARE ASSOCIATES OF CONNECTICUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LECLERC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-924-7334
Mailing Address - Street 1:25 CONSTITUTION BLVD S
Mailing Address - Street 2:PEDI-CARE
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4351
Mailing Address - Country:US
Mailing Address - Phone:203-924-7334
Mailing Address - Fax:203-922-0004
Practice Address - Street 1:25 CONSTITUTION BLVD. SO
Practice Address - Street 2:PEDI-CARE
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-1300
Practice Address - Country:US
Practice Address - Phone:203-924-7334
Practice Address - Fax:203-922-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty