1356348908 NPI number — LAWRENCE J WARTEL MD

Table of content: LAWRENCE J WARTEL MD (NPI 1356348908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356348908 NPI number — LAWRENCE J WARTEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARTEL
Provider First Name:
LAWRENCE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1356348908
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
675 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESHIRE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06410-3153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-250-2125
Provider Business Mailing Address Fax Number:
203-250-2162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
675 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESHIRE
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06410-3153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-272-1811
Provider Business Practice Location Address Fax Number:
203-271-3152
Provider Enumeration Date:
06/28/2005

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: 207V00000X , with the licence number:  013084 , 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: NHP099 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 160007832 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 524517 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0201418-002 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0Q0328 . This is a "HEALTHNET" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 010013084CT01 . This is a "ANTHEM BLUE CROSS & BLUE SHEILD OF CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 07-40924 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001130848 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 013084 . This is a "CONNECTICARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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