Provider Demographics
NPI:1447220462
Name:CAVO, CHARLES A (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:CAVO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3916
Mailing Address - Country:US
Mailing Address - Phone:860-224-6240
Mailing Address - Fax:860-826-4957
Practice Address - Street 1:300 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-3916
Practice Address - Country:US
Practice Address - Phone:860-224-6215
Practice Address - Fax:860-224-6260
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042274207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1255448155OtherGHMC GROUP NPI
CT001422740Medicaid
CT040042274CT23OtherBCBS
CT7715555OtherAETNA
CT2V9662OtherHEALTH NET
CTP3256316OtherOXFORD HEALTH PLANS
CT040042274CT23OtherBLUE CARE FAMILY PLAN
CT1631895OtherCIGNA
CT040042274CT23OtherMEDIBLUE BCBS
CT042274OtherCONNECTICARE
CT160002182Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID
CT001422740Medicaid