Provider Demographics
NPI:1750402038
Name:CONNECTICUT PEDIATRIC OTOLARYNGOLOGY
Entity type:Organization
Organization Name:CONNECTICUT PEDIATRIC OTOLARYNGOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-245-0496
Mailing Address - Street 1:230 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2225
Mailing Address - Country:US
Mailing Address - Phone:203-245-0496
Mailing Address - Fax:203-245-8697
Practice Address - Street 1:230 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2225
Practice Address - Country:US
Practice Address - Phone:203-245-0496
Practice Address - Fax:203-245-8697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0352372080A0000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG29089Medicare UPIN