Provider Demographics
NPI:1861492241
Name:ALLMENDINGER, PHILIP DEFORD
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:DEFORD
Last Name:ALLMENDINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:STE 911
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-522-4158
Mailing Address - Fax:860-524-2652
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:STE 911
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-522-4158
Practice Address - Fax:860-524-2652
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0134822085R0204X, 2086S0129X, 208G00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6191428Medicaid
CT010013482CT05OtherANTHEM BCBS
CT052338OtherCONNECTICARE
CT2214494OtherAETNA
CTP1946707OtherOXFORD
CT0V6080OtherHEALTH NET
CT10143OtherHEALTH NEW ENGLAND
CT1045471 012OtherCIGNA
CT0V6080OtherHEALTH NET