Healthcare Provider Details

I. General information

NPI: 1013005966
Provider Name (Legal Business Name): DIGESTIVE DISEASE CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LIBERTY SQ SECOND FLOOR
NEW BRITAIN CT
06051-2637
US

IV. Provider business mailing address

1 LIBERTY SQ SECOND FLOOR
NEW BRITAIN CT
06051-2637
US

V. Phone/Fax

Practice location:
  • Phone: 860-229-9688
  • Fax: 860-229-5498
Mailing address:
  • Phone: 860-229-9688
  • Fax: 860-229-5498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBORAH L FOSTER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 860-229-9688