Basic Information
| Provider Information | |||||||||
| NPI: | 1538233291 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARDON | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | KATHLEEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1290 SILAS DEANE HWY | ||||||||
| Address2: | |||||||||
| City: | WETHERSFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061094337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609726977 | ||||||||
| FaxNumber: | 8609727040 | ||||||||
| Practice Location | |||||||||
| Address1: | 1781 HIGHLAND AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | CHESHIRE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064101254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032721990 | ||||||||
| FaxNumber: | 2032710668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 01/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 028208 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 282080 | 01 | CT | CONNECTICARE | OTHER | 4124064 | 01 | CT | AETNA | OTHER | 233296 | 01 | CT | CIGNA | OTHER | 0V0425 | 01 | CT | HEALTHNET | OTHER | 010028208CT03 | 01 | CT | BLUE SHIELD | OTHER | 010028208CT04 | 01 | CT | ANTHEM BCBS | OTHER | 12827087 | 05 | CT | MEDICAID | P1024361 | 01 | CT | OXFORD | OTHER |