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OBGYN GROUP OF EASTERN CONNECTICUT P.C. NPI 1376756908


NPI Information

NPI: 1376756908
Provider Name: OBGYN GROUP OF EASTERN CONNECTICUT, P.C.
Classification: Obstetrics & Gynecology - 207V00000X
Entity Type: Organization

CLIA Number: 07D2006798

Address:
2600 TAMARACK AVENUE
SUITE 200
SOUTH WINDSOR, CT
ZIP 06074
Phone: (860) 646-1157
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OBGYN GROUP OF EASTERN CONNECTICUT, P.C. is an obstetrics gynecology in South Windsor, CT. The provider is an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. OBGYN GROUP OF EASTERN CONNECTICUT, P.C. NPI is 1376756908. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

2600 TAMARACK AVENUE
SUITE 200
SOUTH WINDSOR, CT
ZIP 06074-560
Phone: (860) 646-1157
Fax: (860) 646-9877

The provider's authorized official is Kelly Riccitelli .
The authorized official title is Administrator and has the following contact phone number (860) 646-1157.

The CLIA number assigned to this NPI record is 07D2006798 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 5/8/2007 and was last updated on 1/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207V00000XObstetrics & GynecologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1004394251MEDICAIDCONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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