1972592640 NPI number — DR. LINDA M CHAFFKIN M.D.

Table of content: DR. LINDA M CHAFFKIN M.D. (NPI 1972592640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972592640 NPI number — DR. LINDA M CHAFFKIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAFFKIN
Provider First Name:
LINDA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1972592640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 PENNY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBRIDGE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06525-1531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-494-4039
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 SEYMOUR ST
Provider Second Line Business Practice Location Address:
SUITE 507
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06106-5501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-548-1383
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2005

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: 207VE0102X , with the licence number:  030375 , 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: 11184 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V5830 . This is a "HEALTH NET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010030375CT 04 . This is a "ANTHEM BLUE CROSE & BLUE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010030375CT 03 . This is a "ANTHEM BLUE CROSE & BLUE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 3772845 . This is a "AETNA USHEALTH CARE 1-800" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P1053585 . This is a "OXFORD HEALTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001303750-00 . This is a "ANTHEM BLUE CARE FAMILY P" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001303750-01 . This is a "ANTHEM BLUE CARE FAMILY P" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1217755 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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