Healthcare Provider Details

I. General information

NPI: 1962453670
Provider Name (Legal Business Name): PANTCHO G MASLINSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 MANSFIELD AVE
WILLIMANTIC CT
06226-2045
US

IV. Provider business mailing address

349 BEAVER HILL RD
NORTH WINDHAM CT
06256-1254
US

V. Phone/Fax

Practice location:
  • Phone: 860-456-6994
  • Fax: 860-456-6762
Mailing address:
  • Phone: 765-994-5149
  • Fax: 207-351-3478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number72614
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: