Provider Demographics
NPI:1023305455
Name:MIDDLESEX HOSP DBA THORACIC SURG/OBGYN ONOCOLOGY
Entity type:Organization
Organization Name:MIDDLESEX HOSP DBA THORACIC SURG/OBGYN ONOCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:G
Authorized Official - Last Name:CAPECE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:860-358-6110
Mailing Address - Street 1:28 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3654
Mailing Address - Country:US
Mailing Address - Phone:860-358-2780
Mailing Address - Fax:860-358-2781
Practice Address - Street 1:540 SAYBROOK RD STE 180
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4759
Practice Address - Country:US
Practice Address - Phone:860-358-2780
Practice Address - Fax:860-358-2781
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDDLESEX HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-06
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT23646207VX0201X
CT443282086X0206X
CT48090208G00000X
CT33511208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00811Medicare PIN