Provider Demographics
NPI:1962580316
Name:GENERAL THORACIC SURGEONS OF CT, P.D.
Entity type:Organization
Organization Name:GENERAL THORACIC SURGEONS OF CT, P.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:FEDERICO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-787-3488
Mailing Address - Street 1:330 ORCHARD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4417
Mailing Address - Country:US
Mailing Address - Phone:203-787-3488
Mailing Address - Fax:203-787-4914
Practice Address - Street 1:330 ORCHARD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4417
Practice Address - Country:US
Practice Address - Phone:203-787-3488
Practice Address - Fax:203-787-4914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02640Medicare ID - Type UnspecifiedGROUP NUMBER