Provider Demographics
NPI:1851320964
Name:NORTHEASTERN CONNECTICUT CARDIOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:NORTHEASTERN CONNECTICUT CARDIOLOGY ASSOCIATES, PC
Other - Org Name:NECCA, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:WILLAIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRADBURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-963-7519
Mailing Address - Street 1:37 KENNEDY DR STE A
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1946
Mailing Address - Country:US
Mailing Address - Phone:860-963-7519
Mailing Address - Fax:860-963-0668
Practice Address - Street 1:37 KENNEDY DR STE A
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1946
Practice Address - Country:US
Practice Address - Phone:860-963-7519
Practice Address - Fax:860-963-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6945000000207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004396348Medicaid
CT004396348Medicaid
CTCM3360Medicare PIN