Provider Demographics
NPI:1962560458
Name:NEPHROLOGY ASSOCIATES OF NORTHWESTERN CONNECTICUT LLP
Entity type:Organization
Organization Name:NEPHROLOGY ASSOCIATES OF NORTHWESTERN CONNECTICUT LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:KOVALCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-489-1984
Mailing Address - Street 1:780 LITCHFIELD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6268
Mailing Address - Country:US
Mailing Address - Phone:860-489-1984
Mailing Address - Fax:860-496-2195
Practice Address - Street 1:780 LITCHFIELD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6268
Practice Address - Country:US
Practice Address - Phone:860-489-1984
Practice Address - Fax:860-496-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00474Medicare ID - Type Unspecified