Provider Demographics
NPI:1861467367
Name:CRISPINO, CARMINE RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:CARMINE
Middle Name:RAYMOND
Last Name:CRISPINO
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 1:365 MONTAUK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4700
Mailing Address - Country:US
Mailing Address - Phone:860-442-7011
Mailing Address - Fax:860-444-5114
Practice Address - Street 1:365 MONTAUK AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4700
Practice Address - Country:US
Practice Address - Phone:860-442-7011
Practice Address - Fax:860-444-5114
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042164207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010042164CT03OtherBLUE CROSS
P3227288OtherOXFORD
CT001421643Medicaid
I02742Medicare UPIN
CT110009508Medicare ID - Type Unspecified