Basic Information
| Provider Information | |||||||||
| NPI: | 1134205719 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FICARA | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | P.A | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 33440 | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061503440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605227181 | ||||||||
| FaxNumber: | 8602783357 | ||||||||
| Practice Location | |||||||||
| Address1: | 85 SEYMOUR ST | ||||||||
| Address2: | SUITE 325 | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061065501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605227181 | ||||||||
| FaxNumber: | 8602783357 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 000018 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 290001368CT01 | 01 | CT | ANTHEM BLUECROSS | OTHER | OV7275 | 01 | CT | HEALTHNET | OTHER | P2626688 | 01 | CT | OXFORD HEALTHPLAN | OTHER | 142300 | 01 | CT | CONNECTICARE | OTHER | 061028513 | 01 | CT | CIGNA HEALTHPLAN | OTHER | 290001368CT01 | 01 | CT | BLUECAREFAMILY PLAN | OTHER | 30005220 | 01 | CT | RAILROAD MEDICARE | OTHER |