1669635645 NPI number — DR. CARLOS ALBERTO ENCISO CHAVES M.D.

Table of content: DR. CARLOS ALBERTO ENCISO CHAVES M.D. (NPI 1669635645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669635645 NPI number — DR. CARLOS ALBERTO ENCISO CHAVES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENCISO CHAVES
Provider First Name:
CARLOS
Provider Middle Name:
ALBERTO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1669635645
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
675 TOWER AVE
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06112-1273
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-714-2750
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 CHESTNUT HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STAFFORD SPRINGS
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06076-4005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-714-2750
Provider Business Practice Location Address Fax Number:
860-714-8591
Provider Enumeration Date:
07/09/2008

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: 2084P0800X , with the licence number:  49483 , 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)





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