Provider Demographics
NPI:1407828700
Name:PET, PACEY (MD)
Entity type:Individual
Prefix:
First Name:PACEY
Middle Name:
Last Name:PET
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 1:146 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3427
Mailing Address - Country:US
Mailing Address - Phone:860-799-5900
Mailing Address - Fax:860-799-5902
Practice Address - Street 1:146 DANBURY RD
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3427
Practice Address - Country:US
Practice Address - Phone:860-799-5900
Practice Address - Fax:860-799-5902
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT30074207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4329521OtherAETNA
730074OtherCONNECTICARE
9896287OtherCIGNA
P4302536OtherOXFORD
CT004068508Medicaid
P4302536OtherOXFORD