Provider Demographics
NPI:1285706127
Name:MT CARMEL MEDICAL ASSOCIATES, LLP
Entity type:Organization
Organization Name:MT CARMEL MEDICAL ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONACO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-281-6228
Mailing Address - Street 1:2690 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2924
Mailing Address - Country:US
Mailing Address - Phone:203-281-6228
Mailing Address - Fax:203-248-2881
Practice Address - Street 1:2690 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-2924
Practice Address - Country:US
Practice Address - Phone:203-281-6228
Practice Address - Fax:203-248-2881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT27738, 13376, 39321207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010013376CT01OtherDR.SARACCO'S BLUE CROSS
CT001133768Medicaid
CT010039321CT01OtherDR.SUN'S BLUE CROSS
CT0V8915OtherDR.SARACCO'S HEALTH NET
CT2V0374OtherDR.SUN'S HEALTH NET
CT0V8914OtherDR.MONACO'S HEALTH NET
CT0011277385Medicaid
CT010027738CT02OtherDR.MONACO'S BLUE CROSS
CT004188133Medicaid
CT001383214Medicaid
CT110008321Medicare ID - Type UnspecifiedDR. SUN'S MEDICARE
CT0011277385Medicaid
CTH41970Medicare UPIN
CT010027738CT02OtherDR.MONACO'S BLUE CROSS
CTB83140Medicare UPIN
CT001133768Medicaid