1891791323 NPI number — MR. THOMAS PARE' P.T.,A.T.,C.

Table of content: MR. THOMAS PARE' P.T.,A.T.,C. (NPI 1891791323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891791323 NPI number — MR. THOMAS PARE' P.T.,A.T.,C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARE'
Provider First Name:
THOMAS
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.T.,A.T.,C.
Provider Gender Code:
M

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:
1891791323
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
246 E MAIN ST
Provider Second Line Business Mailing Address:
STE 5
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06413-2245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-664-0366
Provider Business Mailing Address Fax Number:
860-669-8206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
246 E MAIN ST
Provider Second Line Business Practice Location Address:
STE 5
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06413-2245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-664-0366
Provider Business Practice Location Address Fax Number:
860-669-8206
Provider Enumeration Date:
06/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  3248 , 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)

  • Identifier: 0567426 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P1270716 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 080003248CT02 . This is a "B/C & B/S" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V8213 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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