Provider Demographics
NPI:1982929816
Name:CANCER SCREENING CENTERS INC
Entity Type:Organization
Organization Name:CANCER SCREENING CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARISSE
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLEMONS FERRARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-303-9000
Mailing Address - Street 1:89 CASTLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:PAWCATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06379-1978
Mailing Address - Country:US
Mailing Address - Phone:860-303-9000
Mailing Address - Fax:860-599-3479
Practice Address - Street 1:9 CASTLE HILL RD
Practice Address - Street 2:
Practice Address - City:PAWCATUCK
Practice Address - State:CT
Practice Address - Zip Code:06379-1958
Practice Address - Country:US
Practice Address - Phone:860-303-9000
Practice Address - Fax:860-599-3479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-03
Last Update Date:2010-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT048178207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT150089OtherNEW YORK LICENSE
CT048178OtherPHYSICIAN LICENSE