Provider Demographics
NPI:1558494575
Name:CONNECTICUT VASCULAR CENTER P.C.
Entity Type:Organization
Organization Name:CONNECTICUT VASCULAR CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, CPC
Authorized Official - Phone:203-288-2886
Mailing Address - Street 1:280 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2132
Mailing Address - Country:US
Mailing Address - Phone:203-288-2886
Mailing Address - Fax:203-288-2576
Practice Address - Street 1:280 STATE ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2132
Practice Address - Country:US
Practice Address - Phone:203-288-2886
Practice Address - Fax:203-288-2576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004115798Medicaid
CT004115798Medicaid