Basic Information
| Provider Information | |||||||||
| NPI: | 1962580316 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GENERAL THORACIC SURGEONS OF CT, P.D. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 330 ORCHARD ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065114417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037873488 | ||||||||
| FaxNumber: | 2037874914 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 ORCHARD ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065114417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037873488 | ||||||||
| FaxNumber: | 2037874914 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FEDERICO | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | ANTHONY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2037873488 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.