Provider Demographics
NPI:1982755849
Name:FARMINGTON PEDIATRIC & ADOLESCENT MEDICINE, LLC
Entity type:Organization
Organization Name:FARMINGTON PEDIATRIC & ADOLESCENT MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIOGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-677-1112
Mailing Address - Street 1:1 FOREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1487
Mailing Address - Country:US
Mailing Address - Phone:860-677-1112
Mailing Address - Fax:860-674-9442
Practice Address - Street 1:1 FOREST PARK DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1487
Practice Address - Country:US
Practice Address - Phone:860-677-1112
Practice Address - Fax:860-674-9442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034605208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004271946Medicaid
CTG04520Medicare UPIN