Provider Demographics
NPI:1316943285
Name:GEDDIS, ANGELA G (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:G
Last Name:GEDDIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:G
Other - Last Name:LORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3916
Mailing Address - Country:US
Mailing Address - Phone:860-224-6282
Mailing Address - Fax:860-826-4959
Practice Address - Street 1:184 EAST ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-2913
Practice Address - Country:US
Practice Address - Phone:860-747-1132
Practice Address - Fax:860-747-2028
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031048208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060040OtherHEALTH NET ID
CT1255448155OtherGHMC NPI ID
CT476805OtherAETNA REF ID
CT010031048CT03OtherBCBS NBCFP PLAINVILLE ID
CT010031048CT04OtherBCBSN BCFP NB ID
CT01031048OtherCIGNA ID
CT912429OtherHEALTH NET REF ID
CT71668401OtherCONNECTICARE ID
CTP369863OtherOXFORD ID
CT126638OtherWELLCARE MEDICARE
CTC01373Medicare ID - Type UnspecifiedGHMC GRP MEDCARE ID
CT010031048CT04OtherBCBSN BCFP NB ID