1477555787 NPI number — DR. RAYMOND L D'AMATO M.D.

Table of content: DR. RAYMOND L D'AMATO M.D. (NPI 1477555787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477555787 NPI number — DR. RAYMOND L D'AMATO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
D'AMATO
Provider First Name:
RAYMOND
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1477555787
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 KENSINGTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BRITAIN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06051-3916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-224-6200
Provider Business Mailing Address Fax Number:
860-224-6260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
136 BERLIN RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
CROMWELL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06416-2627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-635-2810
Provider Business Practice Location Address Fax Number:
860-632-2352
Provider Enumeration Date:
06/01/2005

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: 207R00000X , with the licence number:  017716 , 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: 01217716 . This is a "CIGNA ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060916784009 . This is a "TRICARE HNFS ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P369835 . This is a "OXFORD PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060078 . This is a "HEALTH NET ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010017716CT02 . This is a "BCBS COMMERCIAL N BCFP ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 050843 . This is a "CONNECTICARE ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1255448155 . This is a "GHMC GRP NPI ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 501435 . This is a "AETNA PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 912611 . This is a "HEALTH NET REFERRAL ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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