Provider Demographics
NPI:1952328981
Name:CONNECTICUT RIVER INTERNISTS, LLP
Entity Type:Organization
Organization Name:CONNECTICUT RIVER INTERNISTS, LLP
Other - Org Name:CONNECTICUT RIVER INTERNISTS, LLP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D./PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKSIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-774-5554
Mailing Address - Street 1:8 BURNHAM ST
Mailing Address - Street 2:
Mailing Address - City:TURNERS FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01376-1816
Mailing Address - Country:US
Mailing Address - Phone:413-774-5554
Mailing Address - Fax:413-775-9137
Practice Address - Street 1:8 BURNHAM ST
Practice Address - Street 2:
Practice Address - City:TURNERS FALLS
Practice Address - State:MA
Practice Address - Zip Code:01376-1816
Practice Address - Country:US
Practice Address - Phone:413-774-5554
Practice Address - Fax:413-775-9137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM14838Medicare ID - Type UnspecifiedGROUP NUMBER