Healthcare Provider Details

I. General information

NPI: 1417214214
Provider Name (Legal Business Name): THOMAS JAMES CORREDINE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 07/21/2022
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 DALE RD
AVON CT
06001-4315
US

IV. Provider business mailing address

30 JORDAN LN STE 3
WETHERSFIELD CT
06109-1244
US

V. Phone/Fax

Practice location:
  • Phone: 860-674-8830
  • Fax: 860-674-8984
Mailing address:
  • Phone: 860-263-0253
  • Fax: 860-263-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number055026
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number6151
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number55026
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: