Healthcare Provider Details

I. General information

NPI: 1801805403
Provider Name (Legal Business Name): CONNECTICUT VASCULAR SURGICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BEARD SAWMILL RD STE 250
SHELTON CT
06484-6150
US

IV. Provider business mailing address

501 KINGS HWY E SUITE 112
FAIRFIELD CT
06825-4867
US

V. Phone/Fax

Practice location:
  • Phone: 203-922-7870
  • Fax: 203-922-7872
Mailing address:
  • Phone: 203-382-1900
  • Fax: 203-382-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SETH BARAK BLATTMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 203-922-7870