Provider Demographics
NPI:1477780401
Name:CONNECTICUT CARDIOLOGY CENTER PC
Entity Type:Organization
Organization Name:CONNECTICUT CARDIOLOGY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-643-5443
Mailing Address - Street 1:201 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-3540
Mailing Address - Country:US
Mailing Address - Phone:860-643-5443
Mailing Address - Fax:860-643-9399
Practice Address - Street 1:201 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-3540
Practice Address - Country:US
Practice Address - Phone:860-643-5443
Practice Address - Fax:860-643-9399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028665207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD100007069Medicare PIN