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General NPI Number Information
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NPI Number | 1457361594
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Entity Type | Organization
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Legal Business Name | EASTERN CONNECTICUT IMAGING PC
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 71 HAYNES ST
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City | MANCHESTER
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State | CT
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Zip | 06040-4131
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Country | US
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Telephone | 860-646-1222
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Fax | 860-533-3498
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Provider Business Mailing Address
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Address Line | 341 E CENTER ST PMB #141
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City | MANCHESTER
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State | CT
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Zip | 06040-4445
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Country | US
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Telephone | 860-646-1222
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Fax | 860-533-3498
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Authorized Official
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Title or Position | PARTNER
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Name | TED S METZGER
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Credential | MD
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Telephone | 860-646-1222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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