Provider Demographics
NPI:1154389468
Name:CARDIOVASCULAR PHYSICIANS & CONSULTANTS, LLC
Entity type:Organization
Organization Name:CARDIOVASCULAR PHYSICIANS & CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-874-1512
Mailing Address - Street 1:849 BOSTON POST ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4647
Mailing Address - Country:US
Mailing Address - Phone:203-874-1512
Mailing Address - Fax:203-874-3877
Practice Address - Street 1:849 BOSTON POST RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460
Practice Address - Country:US
Practice Address - Phone:203-874-1512
Practice Address - Fax:203-874-3877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE76712207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004242476Medicaid
CTB38700Medicare UPIN
CT004242476Medicaid