Basic Information
| Provider Information | |||||||||
| NPI: | 1932273299 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'REGAN | ||||||||
| FirstName: | EILEEN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1781 HIGHLAND AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | CHESHIRE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064101254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032721990 | ||||||||
| FaxNumber: | 2032710668 | ||||||||
| Practice Location | |||||||||
| Address1: | 1781 HIGHLAND AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | CHESHIRE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064101254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032721990 | ||||||||
| FaxNumber: | 2032710668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 08/14/2008 | ||||||||
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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 | 029098 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4564088 | 01 | CT | AETNA | OTHER | P1024372 | 01 | CT | OXFORD | OTHER | 010029098CT01 | 01 | CT | BLUE SHIELD | OTHER | 0V0453 | 01 | CT | HEALTHNET | OTHER | 1290981 | 05 | CT | MEDICAID | 212170 | 01 | CT | CIGNA | OTHER | 290980 | 01 | CT | CONNECTICARE | OTHER |