1730195975 NPI number — NORMAN J CAVANAGH DMD, MD

Table of content: NORMAN J CAVANAGH DMD, MD (NPI 1730195975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730195975 NPI number — NORMAN J CAVANAGH DMD, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAVANAGH
Provider First Name:
NORMAN
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD, 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:
1730195975
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 TALCOTT NOTCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06032-1818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-524-2626
Provider Business Mailing Address Fax Number:
860-677-5029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
399 FARMINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06032-1936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-548-7338
Provider Business Practice Location Address Fax Number:
860-524-2654
Provider Enumeration Date:
07/31/2006

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: 204E00000X , with the licence number:  006642 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2082S0099X , with the licence number: 034915 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1730195975 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5037697 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 076642 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06-1406459 . This is a "MULTIPLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06-1406459 . This is a "PIONEER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06-1406459 . This is a "TRICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 002066421 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010034915CT01 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06-1406459 . This is a "FOCUS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06-1406459 . This is a "NORTHEAST HEALTH DIRECT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06-1406459 . This is a "CORVEL" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4124672 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P3881605 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06-1406459 . This is a "COMMUNITY HEALTH NETWORK" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06-1406459 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06-1406459 . This is a "GREAT-WEST HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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