Provider Demographics
NPI:1821096579
Name:DEVANNEY, JAMES F (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:F
Last Name:DEVANNEY
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 1:538 LITCHFIELD ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6669
Mailing Address - Country:US
Mailing Address - Phone:860-496-8990
Mailing Address - Fax:860-496-7301
Practice Address - Street 1:538 LITCHFIELD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6669
Practice Address - Country:US
Practice Address - Phone:860-496-8990
Practice Address - Fax:860-496-7301
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034415174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0000138386401OtherUNITED HEALTHCARE ID
CT010034415CT01OtherBLUE SHIELD PROVIDER ID
CT344150OtherCONNECTICARE ID
CT4339417OtherAETNA PROVIDER ID
CT040296OtherHEALTHNET PROVIDER ID
CT061020840001OtherHEALTHCHOICE OF CT ID
CT1344150Medicaid
CTP638599OtherOXFORD PROVIDER ID
CT00134415001OtherBLUE CARE FAMILY PLAN ID
CTP638599OtherOXFORD PROVIDER ID