Provider Demographics
NPI:1841209657
Name:TOSCANO, ROBERT RAPHAEL (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:RAPHAEL
Last Name:TOSCANO
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 1:33 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:WEATOGUE
Mailing Address - State:CT
Mailing Address - Zip Code:06089-9605
Mailing Address - Country:US
Mailing Address - Phone:860-658-1058
Mailing Address - Fax:860-658-1819
Practice Address - Street 1:33 CANAL ST
Practice Address - Street 2:
Practice Address - City:WEATOGUE
Practice Address - State:CT
Practice Address - Zip Code:06089-9605
Practice Address - Country:US
Practice Address - Phone:860-658-1058
Practice Address - Fax:860-658-1819
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0257932080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010025793CT04OtherBLUE CROSS
CTCONNECTICAREOther795600
CTHEALTHNETOtherOP0414
CTOXFORDOtherHAP379
CT0521793OtherAETNA
CTCIGNAOther0611956000004