Provider Demographics
NPI:1740388859
Name:BALTAZAR, ARTURO ERFE (MD)
Entity Type:Individual
Prefix:
First Name:ARTURO
Middle Name:ERFE
Last Name:BALTAZAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-6351
Mailing Address - Country:US
Mailing Address - Phone:860-589-8141
Mailing Address - Fax:860-589-8578
Practice Address - Street 1:149 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-6351
Practice Address - Country:US
Practice Address - Phone:860-589-8141
Practice Address - Fax:860-589-8578
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT016883207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB39339Medicare UPIN