Provider Demographics
NPI:1669662110
Name:CROVO, ROBERT T (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:T
Last Name:CROVO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 NEW LITCHFIELD ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6414
Mailing Address - Country:US
Mailing Address - Phone:860-489-1661
Mailing Address - Fax:860-489-5147
Practice Address - Street 1:95 NEW LITCHFIELD ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6414
Practice Address - Country:US
Practice Address - Phone:860-489-1661
Practice Address - Fax:860-489-5147
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000032213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTOVO493OtherHEALTHNET
CT480069612OtherMEDICARE RAILROAD
CT0207740001OtherDME SUPPLIER
CT032000OtherCONNECTICARE
CT030000032CT02OtherANTHEM
CT004006490Medicaid
CT2740028OtherUNITED HEALTHCARE
CT004006490Medicaid
CT030000032CT02OtherANTHEM