Provider Demographics
NPI:1922009091
Name:CHIAPPETTA, RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:
Last Name:CHIAPPETTA
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 1:360 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2503
Mailing Address - Country:US
Mailing Address - Phone:860-628-4719
Mailing Address - Fax:860-620-0188
Practice Address - Street 1:360 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2503
Practice Address - Country:US
Practice Address - Phone:860-628-4719
Practice Address - Fax:860-620-0188
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT021394207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTOR0343OtherHEALTHNET
CT060296OtherCONNECTICARE
CT010021394CT01OtherBLUE CROSS BLUE SHIELD
CT1213941Medicaid
CTHAS012OtherOXFORD
CT4002828OtherAETNA
CT0944776-001OtherCIGNA
CT060296OtherCONNECTICARE
CT4002828OtherAETNA