Provider Demographics
NPI:1619323706
Name:NORWICH ORTHOPEDIC GROUP, PC
Entity Type:Organization
Organization Name:NORWICH ORTHOPEDIC GROUP, PC
Other - Org Name:ORTHOPEDIC PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:PASHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-889-7345
Mailing Address - Street 1:82 NEW PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH FRANKLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06254-1807
Mailing Address - Country:US
Mailing Address - Phone:860-889-7345
Mailing Address - Fax:860-885-7229
Practice Address - Street 1:11 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-1904
Practice Address - Country:US
Practice Address - Phone:860-889-7345
Practice Address - Fax:860-885-7229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004002358Medicaid
CTC00123Medicare PIN