Provider Demographics
NPI:1801805403
Name:CONNECTICUT VASCULAR SURGICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:CONNECTICUT VASCULAR SURGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:BARAK
Authorized Official - Last Name:BLATTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-922-7870
Mailing Address - Street 1:501 KINGS HWY E
Mailing Address - Street 2:SUITE 112
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-4867
Mailing Address - Country:US
Mailing Address - Phone:203-382-1900
Mailing Address - Fax:203-382-0019
Practice Address - Street 1:100 BEARD SAWMILL RD STE 250
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6150
Practice Address - Country:US
Practice Address - Phone:203-922-7870
Practice Address - Fax:203-922-7872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004198489Medicaid
CTC02533Medicare ID - Type Unspecified