Provider Demographics
NPI:1558418707
Name:NORWICH ENDOCRINOLOGY LLC
Entity Type:Organization
Organization Name:NORWICH ENDOCRINOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSELI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-859-3006
Mailing Address - Street 1:119 SACHEM ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-4128
Mailing Address - Country:US
Mailing Address - Phone:860-859-3006
Mailing Address - Fax:860-859-1222
Practice Address - Street 1:119 SACHEM ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-4128
Practice Address - Country:US
Practice Address - Phone:860-859-3006
Practice Address - Fax:860-859-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040484207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
11045496OtherCAQH NUMBER
BC7851264OtherDEA NUMBER
H76435Medicare UPIN