Provider Demographics
NPI:1922103365
Name:BATIANCILA, THELMA V (MD)
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:V
Last Name:BATIANCILA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 BOSTON POST RD STE E
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3548
Mailing Address - Country:US
Mailing Address - Phone:475-209-9130
Mailing Address - Fax:203-298-4380
Practice Address - Street 1:477 BOSTON POST RD STE E
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3548
Practice Address - Country:US
Practice Address - Phone:475-209-9130
Practice Address - Fax:203-298-4380
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT20036207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400104775Medicare PIN