Provider Demographics
NPI:1659449957
Name:RHEUMATOLOGY AND ALLERGY INSTITUTE OF CT, LLC
Entity Type:Organization
Organization Name:RHEUMATOLOGY AND ALLERGY INSTITUTE OF CT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-646-9929
Mailing Address - Street 1:361 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4127
Mailing Address - Country:US
Mailing Address - Phone:860-646-9929
Mailing Address - Fax:860-646-7999
Practice Address - Street 1:361 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4127
Practice Address - Country:US
Practice Address - Phone:860-646-9929
Practice Address - Fax:860-646-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039413207K00000X
CT033888207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4341750001Medicare NSC
C02766Medicare ID - Type UnspecifiedMC GROUP ID