Provider Demographics
NPI:1477588002
Name:CONNECTICUT HEART PHYSICIANS, INC.
Entity Type:Organization
Organization Name:CONNECTICUT HEART PHYSICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:F
Authorized Official - Last Name:LASALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-249-9175
Mailing Address - Street 1:PO BOX 262
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-0262
Mailing Address - Country:US
Mailing Address - Phone:860-688-0033
Mailing Address - Fax:877-306-1480
Practice Address - Street 1:835 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2363
Practice Address - Country:US
Practice Address - Phone:860-688-0033
Practice Address - Fax:877-306-1480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB9683Medicare PIN
CB9388Medicare PIN
CF8932Medicare PIN
CTC00775Medicare PIN