Provider Demographics
NPI:1477555787
Name:D'AMATO, RAYMOND L (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:L
Last Name:D'AMATO
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 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:860-224-6200
Mailing Address - Fax:860-224-6260
Practice Address - Street 1:136 BERLIN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2627
Practice Address - Country:US
Practice Address - Phone:860-635-2810
Practice Address - Fax:860-632-2352
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017716207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT01217716OtherCIGNA ID
CT060916784009OtherTRICARE HNFS ID
CTP369835OtherOXFORD PROVIDER ID
CT060078OtherHEALTH NET ID
CT010017716CT02OtherBCBS COMMERCIAL N BCFP ID
CT050843OtherCONNECTICARE ID
CT1255448155OtherGHMC GRP NPI ID
CT501435OtherAETNA PROVIDER ID
CT912611OtherHEALTH NET REFERRAL ID
CTP369835OtherOXFORD PROVIDER ID
CT060916784009OtherTRICARE HNFS ID