Provider Demographics
NPI:1962651968
Name:CONNECTICUT KIDNEY & HYPERTENSION SPECIALISTS, LLC
Entity Type:Organization
Organization Name:CONNECTICUT KIDNEY & HYPERTENSION SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:CIAMPI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-597-9733
Mailing Address - Street 1:140 GRANDVIEW AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2505
Mailing Address - Country:US
Mailing Address - Phone:203-597-9733
Mailing Address - Fax:203-597-9732
Practice Address - Street 1:140 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2505
Practice Address - Country:US
Practice Address - Phone:203-597-9733
Practice Address - Fax:203-597-9732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030022207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001300227Medicaid
CTC02772Medicare PIN