Provider Demographics
NPI:1669469839
Name:AVE'LALLEMANT, ROBERT AJ (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:AJ
Last Name:AVE'LALLEMANT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:300 KENSINGTON AVE
Mailing Address - Street 2:GROVE HILL MEDICAL CENTER
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3916
Mailing Address - Country:US
Mailing Address - Phone:860-826-4453
Mailing Address - Fax:860-826-6219
Practice Address - Street 1:1 LAKE ST
Practice Address - Street 2:GROVE HILL MEDICAL CENTER
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1396
Practice Address - Country:US
Practice Address - Phone:860-826-4453
Practice Address - Fax:860-826-6219
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT040461208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1255448155OtherGHMC GROUP NPI
CT0007520370OtherAETNA
CT040461OtherCONNECTICARE
CTP2655517OtherOXFORD
CT010040461CT04OtherBCBS & BCFP
CT1598304-004OtherCIGNA
CT2V6808OtherHEALTH NET
CT2V6808OtherHEALTH NET
H62990Medicare UPIN