Provider Demographics
NPI:1922161819
Name:PRIMARY CARE PHYSICIANS OF CENTRAL CT
Entity Type:Organization
Organization Name:PRIMARY CARE PHYSICIANS OF CENTRAL CT
Other - Org Name:PCPCC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:ERCOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-747-5756
Mailing Address - Street 1:7 N WASHINGTON ST STE 106
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-1957
Mailing Address - Country:US
Mailing Address - Phone:860-747-5756
Mailing Address - Fax:860-747-5074
Practice Address - Street 1:7 N WASHINGTON ST
Practice Address - Street 2:106
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1957
Practice Address - Country:US
Practice Address - Phone:860-747-5756
Practice Address - Fax:860-747-5074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT014236174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C02159Medicare ID - Type Unspecified