Basic Information
| Provider Information | |||||||||
| NPI: | 1437252806 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STARLING PHYSICIANS PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LAB DEPARTMENT AT STARLING PHYSICIANS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2110 SILAS DEANE HWY | ||||||||
| Address2: | STARLING PHYSICIANS | ||||||||
| City: | ROCKY HILL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060672313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602583470 | ||||||||
| FaxNumber: | 8605716800 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 LAKE ST | ||||||||
| Address2: | GROVE HILL MEDICAL CENTER | ||||||||
| City: | NEW BRITAIN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060521396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608274600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 06/01/2016 | ||||||||
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| AuthorizedOfficialLastName: | GENOVESI | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 8602246266 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 004118106 | 05 | CT | MEDICAID | 070CL0131CT03 | 01 | CT | BCBS COMMERCIAL | OTHER | 690005500 | 01 | CT | RAIL ROAD MEDICARE | OTHER | 070CL0131CT03 | 01 | CT | BLUE CARE FAMILY PLAN | OTHER | 070CL0131CT03 | 01 | CT | BCBS MEDIBLUE | OTHER | 140440. | 01 | CT | WELLCARE MEDICARE | OTHER |