Provider Demographics
NPI:1255428132
Name:CARSELI, CONSTANTIN (MD)
Entity type:Individual
Prefix:
First Name:CONSTANTIN
Middle Name:
Last Name:CARSELI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 SACHEM ST.
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-4128
Mailing Address - Country:US
Mailing Address - Phone:860-859-3006
Mailing Address - Fax:860-859-1222
Practice Address - Street 1:119 SACHEM ST.
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-4128
Practice Address - Country:US
Practice Address - Phone:860-859-3006
Practice Address - Fax:860-859-1222
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040484207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001404847Medicaid
110008756Medicare ID - Type Unspecified
CT001404847Medicaid