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

Table of content: DR. KACY RENEE LANE D.D.S. (NPI 1316280076)

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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