1376596825 NPI number — NEW LONDON CANCER CENTER, P.C.

Table of content: (NPI 1376596825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376596825 NPI number — NEW LONDON CANCER CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW LONDON CANCER CENTER, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1376596825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
196 PARKWAY S
Provider Second Line Business Mailing Address:
SUITE 304
Provider Business Mailing Address City Name:
WATERFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06385-1234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-442-7027
Provider Business Mailing Address Fax Number:
866-861-9119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
196 PARKWAY S
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06385-1234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-443-4455
Provider Business Practice Location Address Fax Number:
860-447-8961
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOVIL
Authorized Official First Name:
MITHLESH
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
860-443-4455

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , 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: 004222600 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008022601 . This is a "MEDICAID APRN GROUP" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com