Provider Demographics
NPI:1457361594
Name:EASTERN CONNECTICUT IMAGING PC
Entity Type:Organization
Organization Name:EASTERN CONNECTICUT IMAGING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:S
Authorized Official - Last Name:METZGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-646-1222
Mailing Address - Street 1:341 E CENTER ST
Mailing Address - Street 2:PMB #141
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4445
Mailing Address - Country:US
Mailing Address - Phone:860-646-1222
Mailing Address - Fax:860-533-3498
Practice Address - Street 1:71 HAYNES ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4131
Practice Address - Country:US
Practice Address - Phone:860-646-1222
Practice Address - Fax:860-533-3498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4000188Medicaid