Provider Demographics
NPI:1558358523
Name:TADDEO, ROBERT L (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:TADDEO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 KENSINGTON AVE
Mailing Address - Street 2:GROVE HILL MEDICAL CENTER
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3916
Mailing Address - Country:US
Mailing Address - Phone:860-832-8150
Mailing Address - Fax:860-224-6298
Practice Address - Street 1:300 KENSINGTON AVE
Practice Address - Street 2:GROVE HILL MEDICAL CENTER
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-3916
Practice Address - Country:US
Practice Address - Phone:860-832-8150
Practice Address - Fax:860-224-6298
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT025949207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110071620OtherRAIL ROAD MEDICARE
CT050481OtherCONNECTICARE
CT135758OtherWELLCARE MEDICARE
CTP369695OtherOXFORD
CT476780OtherAETNA
CT060037OtherHEALTH NET
CT1255448155OtherGHMC GROUP NPI ID
CT001259498Medicaid
CT010025949CT01OtherBCBS & BCFP ID
CT004215324Medicaid
CT01025949OtherCIGNA
CT1255448155OtherGHMC GROUP NPI ID
CTC01373Medicare ID - Type UnspecifiedGHMC GROUP MEDICARE ID
CT001259498Medicaid