Provider Demographics
NPI:1245275981
Name:ARTHRITIS CENTER OF CONNECTICUT. - PC
Entity type:Organization
Organization Name:ARTHRITIS CENTER OF CONNECTICUT. - PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-755-5555
Mailing Address - Street 1:1389 W MAIN ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3104
Mailing Address - Country:US
Mailing Address - Phone:203-755-5555
Mailing Address - Fax:203-573-8523
Practice Address - Street 1:1389 W MAIN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3104
Practice Address - Country:US
Practice Address - Phone:203-755-5555
Practice Address - Fax:203-573-8523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT016893207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004085636Medicaid
COB84006Medicare UPIN
CT820000010Medicare ID - Type Unspecified