Provider Demographics
NPI:1316918089
Name:TE, VICTORIO GO (MD)
Entity type:Individual
Prefix:DR
First Name:VICTORIO
Middle Name:GO
Last Name:TE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 QUARRY ST
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-1225
Mailing Address - Country:US
Mailing Address - Phone:860-456-2201
Mailing Address - Fax:860-450-1660
Practice Address - Street 1:90 QUARRY ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-1225
Practice Address - Country:US
Practice Address - Phone:860-456-2201
Practice Address - Fax:860-450-1660
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042927207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT042927OtherCONNECTICARE
CT042927OtherLICENSE
CTP00752315OtherRR MEDICARE
CT001429274Medicaid
CT7069588OtherAETNA
CT429034OtherWELLCARE
CT7069588OtherAETNA
CT042927OtherLICENSE
CT110010478Medicare PIN