Provider Demographics
NPI:1295296424
Name:CTPC01 PC
Entity type:Organization
Organization Name:CTPC01 PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-309-1891
Mailing Address - Street 1:7 WATSON DR
Mailing Address - Street 2:
Mailing Address - City:WEST SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06092-2233
Mailing Address - Country:US
Mailing Address - Phone:860-866-4321
Mailing Address - Fax:860-866-4423
Practice Address - Street 1:1171 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3963
Practice Address - Country:US
Practice Address - Phone:860-866-4321
Practice Address - Fax:860-866-4423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-29
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty