1659307916 NPI number — LISA MARIE TANGUAY PA

Table of content: THOMAS CASS PH.D. (NPI 1407247976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659307916 NPI number — LISA MARIE TANGUAY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANGUAY
Provider First Name:
LISA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WARYCH
Provider Other First Name:
LISA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659307916
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
56 FRANKLIN ST
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
WATERBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06706-1221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-709-8873
Provider Business Mailing Address Fax Number:
203-709-8689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56 FRANKLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06706-1221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-709-6314
Provider Business Practice Location Address Fax Number:
203-709-6089
Provider Enumeration Date:
06/25/2006

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: 363AS0400X , with the licence number:  000863 , 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: 061470493 . This is a "COVENTRY/FIRST HEALTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 080863 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 290000863CT11 . This is a "ANTHEM BCBS CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V1632 . This is a "HEALTHNET/COMMERCIAL" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008010398 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 208796 . This is a "WELLCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 22-59899 . This is a "AMERICHOICE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 877800 . This is a "USA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 9886225 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P3134207 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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