Healthcare Provider Details

I. General information

NPI: 1659449957
Provider Name (Legal Business Name): RHEUMATOLOGY AND ALLERGY INSTITUTE OF CT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 MAIN ST
MANCHESTER CT
06040-4127
US

IV. Provider business mailing address

361 MAIN ST
MANCHESTER CT
06040-4127
US

V. Phone/Fax

Practice location:
  • Phone: 860-646-9929
  • Fax: 860-646-7999
Mailing address:
  • Phone: 860-646-9929
  • Fax: 860-646-7999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number039413
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number033888
License Number StateCT

VIII. Authorized Official

Name: DR. BARBARA KAGE
Title or Position: PRESIDENT, LLC
Credential: MD
Phone: 860-646-9929