1699890723 NPI number — DR. PHILIP FLEMMING PACELLI III MD DMD

Table of content: DR. PHILIP FLEMMING PACELLI III MD DMD (NPI 1699890723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699890723 NPI number — DR. PHILIP FLEMMING PACELLI III MD DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PACELLI
Provider First Name:
PHILIP
Provider Middle Name:
FLEMMING
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
MD DMD
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:
1699890723
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
166 CHERRY STREET
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
NEW CANAAN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-972-1581
Provider Business Mailing Address Fax Number:
203-972-1980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
166 CHERRY STREET
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
NEW CANAAN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-972-1581
Provider Business Practice Location Address Fax Number:
203-972-1980
Provider Enumeration Date:
03/20/2007

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: 204E00000X , with the licence number:  007900 , 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: CV2783 . This is a "HEALTH NET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P2552103 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 020007900CT02 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com