Healthcare Provider Details

I. General information

NPI: 1740315761
Provider Name (Legal Business Name): CONNECTICUT IMAGING PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 SILAS DEANE HWY SUITE 100
WETHERSFIELD CT
06109-4362
US

IV. Provider business mailing address

1260 SILAS DEANE HWY STE 104
WETHERSFIELD CT
06109-4363
US

V. Phone/Fax

Practice location:
  • Phone: 860-563-7844
  • Fax: 860-563-7871
Mailing address:
  • Phone: 860-289-3375
  • Fax: 860-290-4108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: BLAKE G GRAVES
Title or Position: SR VP RCM
Credential:
Phone: 312-919-8317