Basic Information
Provider Information | |||||||||
NPI: | 1326000860 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CHIRNOMAS | ||||||||
FirstName: | SARAH | ||||||||
MiddleName: | DEBORAH | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HURWITZ | ||||||||
OtherFirstName: | DEBBIE | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 6 TUCKER MEADOW RD | ||||||||
Address2: |   | ||||||||
City: | WOODBRIDGE | ||||||||
State: | CT | ||||||||
PostalCode: | 065251943 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6177214434 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 333 CEDAR ST | ||||||||
Address2: | 2073 LMP | ||||||||
City: | NEW HAVEN | ||||||||
State: | CT | ||||||||
PostalCode: | 065103206 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2037854640 | ||||||||
FaxNumber: | 2037372228 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/03/2006 | ||||||||
LastUpdateDate: | 08/13/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0207X | 219721 | MA | Y |   | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology |
ID Information
ID | Type | State | Issuer | Description | 2102781 | 01 |   | MASSHEALTH | OTHER | 219721 | 01 |   | TUFTS | OTHER | J28405 | 01 | MA | MA BLUE CROSS BLUE SHIELD | OTHER | J28405 | 01 |   | INDEMNITY | OTHER | J28405 | 01 |   | BC ELECT | OTHER | J28405 | 01 |   | HMO BLUE | OTHER | 2102781 | 05 | MA |   | MEDICAID |