1841257185 NPI number — ERIC D GRAHLING MD

Table of content: ERIC D GRAHLING MD (NPI 1841257185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841257185 NPI number — ERIC D GRAHLING MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAHLING
Provider First Name:
ERIC
Provider Middle Name:
D
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:
1841257185
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
440 NEW BRITAIN AVE
Provider Second Line Business Mailing Address:
COMPREHENSIVE PAIN MANAGEMENT OF CENTRAL CT, LLC
Provider Business Mailing Address City Name:
PLAINVILLE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-793-0500
Provider Business Mailing Address Fax Number:
860-793-1116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
440 NEW BRITAIN AVE
Provider Second Line Business Practice Location Address:
COMPREHENSIVE PAIN MANAGEMENT OF CENTRAL CT, LLC
Provider Business Practice Location Address City Name:
PLAINVILLE
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-793-0500
Provider Business Practice Location Address Fax Number:
860-793-1116
Provider Enumeration Date:
04/28/2006

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: 208VP0014X , with the licence number:  045053 , 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: 1770776023 . This is a "MEDICARE NPI" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010045053CT01 . This is a "BCBS PROVIDER #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".