Provider Demographics
NPI:1649257957
Name:CONNECTICUT CARDIOTHORACIC SURGICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:CONNECTICUT CARDIOTHORACIC SURGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PINKERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-524-5905
Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:STE 725
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-524-5905
Mailing Address - Fax:860-522-3951
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:STE 725
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-524-5905
Practice Address - Fax:860-522-3951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01845Medicare PIN