1437136132 NPI number — PHILIP J KARANIAN MD

Table of content: PHILIP J KARANIAN MD (NPI 1437136132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437136132 NPI number — PHILIP J KARANIAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARANIAN
Provider First Name:
PHILIP
Provider Middle Name:
J
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:
1437136132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 JORDAN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WETHERSFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06109-1278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-263-0253
Provider Business Mailing Address Fax Number:
860-263-0262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 ISHAM RD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
WEST HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06107-2204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-522-6118
Provider Business Practice Location Address Fax Number:
860-246-0122
Provider Enumeration Date:
12/23/2005

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:  029480 , 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: 001294800 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010029480CT01 . This is a "BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 029480 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com