Provider Demographics
NPI:1780727925
Name:NORWICH CARDIAC MEDICINE LLC
Entity type:Organization
Organization Name:NORWICH CARDIAC MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAKRABARTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-518-0126
Mailing Address - Street 1:130 NEW LONDON TPKE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2624
Mailing Address - Country:US
Mailing Address - Phone:860-518-0126
Mailing Address - Fax:
Practice Address - Street 1:130 NEW LONDON TPKE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2624
Practice Address - Country:US
Practice Address - Phone:860-518-0126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTDF8408OtherRAIL ROAD MEDICARE
CT=========Medicaid
CTC03675Medicare PIN