Provider Demographics
NPI:1770776023
Name:COMPREHENSIVE PAIN MANAGEMENT OF CENTRAL CONNECTICUT, LLC
Entity type:Organization
Organization Name:COMPREHENSIVE PAIN MANAGEMENT OF CENTRAL CONNECTICUT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER / SOLE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRAHLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-793-0500
Mailing Address - Street 1:440 NEW BRITAIN AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-2016
Mailing Address - Country:US
Mailing Address - Phone:860-793-0500
Mailing Address - Fax:860-793-1116
Practice Address - Street 1:440 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-2016
Practice Address - Country:US
Practice Address - Phone:860-793-0500
Practice Address - Fax:860-793-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045053208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010045054CT02OtherBCBS PROVIDER NUMBER-SOUTHINGTON
CT010045053CT01OtherBCBS PROVIDER NUMBER- PLAINVILLE
CT1770776023OtherMEDICARE NPI
CT010045054CT02OtherBCBS PROVIDER NUMBER-SOUTHINGTON