Provider Demographics
NPI:1689882359
Name:CARDIOTHORACIC AND VASCULAR GROUP
Entity Type:Organization
Organization Name:CARDIOTHORACIC AND VASCULAR GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:R
Authorized Official - Last Name:FAZZONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-562-5115
Mailing Address - Street 1:175 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4301
Mailing Address - Country:US
Mailing Address - Phone:203-562-5115
Mailing Address - Fax:203-784-4181
Practice Address - Street 1:175 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4301
Practice Address - Country:US
Practice Address - Phone:203-562-5115
Practice Address - Fax:203-784-4181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty