Provider Demographics
NPI:1457396145
Name:BACKE, HENRY A (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:A
Last Name:BACKE
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 1:305 BLACK ROCK TPKE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-5508
Mailing Address - Country:US
Mailing Address - Phone:203-337-2600
Mailing Address - Fax:203-337-2622
Practice Address - Street 1:305 BLACK ROCK TPKE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-5508
Practice Address - Country:US
Practice Address - Phone:203-337-2600
Practice Address - Fax:203-337-2622
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032983207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010031715CT01OtherANTHEM BC/BS
CT0V1246OtherHEALTH NET
TINOtherFIRST HEALTH
CT26K532OtherEMPIRE BC/BS
CT760105OtherCONNECTICARE
TINOtherNEHCA HMC / PPO
TINOtherCIGNA
TINOtherNATIONAL PROVIDER NETWORK
CTZS325OtherOXFORD HEALTH PLANS
CT2065202OtherAETNA
TINOtherPIONEER
TINOtherUNITED HEALTHCARE
TINOtherPOMCO
CT001329839Medicaid
TINOtherNORTHEAST HELATH DIRECT
TINOtherORTHONET
TINOtherCORVEL
TINOtherGREAT WEST
CT26K532OtherEMPIRE BC/BS
TINOtherNORTHEAST HELATH DIRECT