Healthcare Provider Details

I. General information

NPI: 1982878310
Provider Name (Legal Business Name): HENRY PAUL CHICAIZA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

60 HARTLAND ST
EAST HARTFORD CT
06108-3250
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-9000
  • Fax:
Mailing address:
  • Phone: 860-837-5614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number275253
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number051556
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: