Provider Demographics
NPI:1811191216
Name:EASTERN CONNECTICUT PAIN TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:EASTERN CONNECTICUT PAIN TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAGGIOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-885-0333
Mailing Address - Street 1:190 W TOWN ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2131
Mailing Address - Country:US
Mailing Address - Phone:860-885-0333
Mailing Address - Fax:860-885-1319
Practice Address - Street 1:190 W TOWN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2131
Practice Address - Country:US
Practice Address - Phone:860-885-0333
Practice Address - Fax:860-885-1319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035017207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2V8671OtherHEALTHNET OF THE NORTHEAST
CT7135534005OtherCIGNA
CTP2176298OtherOXFORD
CT001350173Medicaid
CT5588518OtherAETNA
CT035017OtherCONNECTICARE
CTP2176298OtherOXFORD
CT050001195Medicare ID - Type Unspecified