Basic Information
| Provider Information | |||||||||
| NPI: | 1457396145 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BACKE | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 BLACK ROCK TPKE | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068255508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033372600 | ||||||||
| FaxNumber: | 2033372622 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 BLACK ROCK TPKE | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068255508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033372600 | ||||||||
| FaxNumber: | 2033372622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 03/27/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 032983 | CT | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0106X | 032983 | CT | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
ID Information
| ID | Type | State | Issuer | Description | 010031715CT01 | 01 | CT | ANTHEM BC/BS | OTHER | 0V1246 | 01 | CT | HEALTH NET | OTHER | TIN | 01 | FIRST HEALTH | OTHER | 26K532 | 01 | CT | EMPIRE BC/BS | OTHER | 760105 | 01 | CT | CONNECTICARE | OTHER | TIN | 01 | NEHCA HMC / PPO | OTHER | TIN | 01 | CIGNA | OTHER | TIN | 01 | NATIONAL PROVIDER NETWORK | OTHER | ZS325 | 01 | CT | OXFORD HEALTH PLANS | OTHER | 2065202 | 01 | CT | AETNA | OTHER | TIN | 01 | PIONEER | OTHER | TIN | 01 | UNITED HEALTHCARE | OTHER | TIN | 01 | POMCO | OTHER | 001329839 | 05 | CT | MEDICAID | TIN | 01 | NORTHEAST HELATH DIRECT | OTHER | TIN | 01 | ORTHONET | OTHER | TIN | 01 | CORVEL | OTHER | TIN | 01 | GREAT WEST | OTHER |