Provider Demographics
NPI:1871513283
Name:LITCHFIELD COUNTY GASTROENTEROLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:LITCHFIELD COUNTY GASTROENTEROLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:LINDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-496-0455
Mailing Address - Street 1:245 ALVORD PARK RD
Mailing Address - Street 2:BUILDING B
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3493
Mailing Address - Country:US
Mailing Address - Phone:860-496-0455
Mailing Address - Fax:860-496-2793
Practice Address - Street 1:245 ALVORD PARK RD
Practice Address - Street 2:BUILDING B
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3493
Practice Address - Country:US
Practice Address - Phone:860-496-0455
Practice Address - Fax:860-496-2793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004195823Medicaid
CTC02473Medicare UPIN