1366555658 NPI number — CONNECTICUT ONCOLOGY & HEMATOLOGY, LLP

Table of content: DR. RONALD LEE FREEMAN M.D. (NPI 1508862384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366555658 NPI number — CONNECTICUT ONCOLOGY & HEMATOLOGY, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNECTICUT ONCOLOGY & HEMATOLOGY, LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366555658
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 KENNEDY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TORRINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06790-3096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-482-5384
Provider Business Mailing Address Fax Number:
860-496-4951

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 KENNEDY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TORRINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06790-3096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-482-5384
Provider Business Practice Location Address Fax Number:
860-496-4951
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOWENTHAL
Authorized Official First Name:
IVAN
Authorized Official Middle Name:
STEPHEN
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
860-482-5384

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  18789 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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