Provider Demographics
NPI:1922286541
Name:RHEUMATOLOGY AND INTERNAL MEDICINE ASSOC LLC
Entity Type:Organization
Organization Name:RHEUMATOLOGY AND INTERNAL MEDICINE ASSOC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERMANO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUADAGNOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-371-6969
Mailing Address - Street 1:3180 MAIN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4237
Mailing Address - Country:US
Mailing Address - Phone:203-371-6969
Mailing Address - Fax:203-371-2980
Practice Address - Street 1:3180 MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4237
Practice Address - Country:US
Practice Address - Phone:203-371-6969
Practice Address - Fax:203-371-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030610174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110008821Medicare PIN
CT110008822Medicare PIN
CT1110008819Medicare PIN