Provider Demographics
NPI:1306283718
Name:POUNDS MEDICAL WEIGHT LOSS TRANSFORMATION PC
Entity type:Organization
Organization Name:POUNDS MEDICAL WEIGHT LOSS TRANSFORMATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:860-906-1732
Mailing Address - Street 1:125 LASALLE RD
Mailing Address - Street 2:STE 208
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2322
Mailing Address - Country:US
Mailing Address - Phone:860-906-1732
Mailing Address - Fax:860-906-1269
Practice Address - Street 1:125 LASALLE RD
Practice Address - Street 2:STE 208
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2322
Practice Address - Country:US
Practice Address - Phone:860-906-1732
Practice Address - Fax:860-906-1269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042274208000000X, 363L00000X, 207VB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VB0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObesity MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty