Healthcare Provider Details

I. General information

NPI: 1558494575
Provider Name (Legal Business Name): CONNECTICUT VASCULAR CENTER P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 STATE ST
NORTH HAVEN CT
06473-2132
US

IV. Provider business mailing address

280 STATE ST
NORTH HAVEN CT
06473-2132
US

V. Phone/Fax

Practice location:
  • Phone: 203-288-2886
  • Fax: 203-288-2576
Mailing address:
  • Phone: 203-288-2886
  • Fax: 203-288-2576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ROBIN MASON
Title or Position: BILLING MANAGER
Credential: LPN, CPC
Phone: 203-288-2886