| Griffin Faculty Physicians, Inc. | |
|
67 Maple Ave 2nd Floor Derby CT 06418-1328 | |
| (203) 732-1330 | |
| (203) 732-1332 |
| Full Name | Griffin Faculty Physicians, Inc. |
|---|---|
| Speciality | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| Location | 67 Maple Ave, Derby, Connecticut |
| Authorized Official Name and Position | Adam Dworkin (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2037321508 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Griffin Faculty Physicians, Inc. 67 Maple Ave 2nd Floor Derby CT 06418-1328 Ph: (203) 732-1330 | Griffin Faculty Physicians, Inc. 67 Maple Ave 2nd Floor Derby CT 06418-1328 Ph: (203) 732-1330 |
| NPI Number | 1598755605 |
|---|---|
| Provider Enumeration Date | 10/28/2005 |
| Last Update Date | 02/22/2018 |
| Medicare PECOS PAC ID | 7618871997 |
|---|---|
| Medicare Enrollment ID | O20031120000158 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598755605 | NPI | - | NPPES |
| Provider Name | Magdalen S Mauriello |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770666059 PECOS PAC ID: 0749186393 Enrollment ID: I20031212000298 |
| Provider Name | Katherine N Bunger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164526646 PECOS PAC ID: 4385636992 Enrollment ID: I20040402000058 |
| Provider Name | Scott Vander Vennet |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1427087980 PECOS PAC ID: 3577559277 Enrollment ID: I20040420001361 |
| Provider Name | Frederick A Browne |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1588641955 PECOS PAC ID: 1456335900 Enrollment ID: I20040614001348 |
| Provider Name | Kathleen M Chaisson |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1932130259 PECOS PAC ID: 7113906223 Enrollment ID: I20040714000272 |
| Provider Name | Benjamin J Zigun |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083682900 PECOS PAC ID: 2668452228 Enrollment ID: I20040723000318 |
| Provider Name | Andrew Onshing Chow |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376583245 PECOS PAC ID: 3375509284 Enrollment ID: I20041202000578 |
| Provider Name | Dinesh Singh |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1346225638 PECOS PAC ID: 4385548197 Enrollment ID: I20041214000935 |
| Provider Name | Leland J Soto |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1801823729 PECOS PAC ID: 8325940992 Enrollment ID: I20050719000256 |
| Provider Name | Jennifer L Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164409587 PECOS PAC ID: 1850316415 Enrollment ID: I20051012000819 |
| Provider Name | Wajahat Zafar Mehal |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1487637781 PECOS PAC ID: 9830113547 Enrollment ID: I20060120000684 |
| Provider Name | Holly Major |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215034806 PECOS PAC ID: 0941209126 Enrollment ID: I20061218000010 |
| Provider Name | Rhianon N Iassogna Roman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457422057 PECOS PAC ID: 1456351022 Enrollment ID: I20070104000214 |
| Provider Name | Denise Barajas |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1689787210 PECOS PAC ID: 8426050964 Enrollment ID: I20070212000679 |
| Provider Name | Joseph A Camilleri |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1376560813 PECOS PAC ID: 2668416124 Enrollment ID: I20070302000209 |
| Provider Name | Brian L Beaulieu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588608384 PECOS PAC ID: 7214032341 Enrollment ID: I20070419000046 |
| Provider Name | Liqun Song |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1699839852 PECOS PAC ID: 9032217377 Enrollment ID: I20070609000069 |
| Provider Name | Susan W Ade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447447008 PECOS PAC ID: 7315036050 Enrollment ID: I20071204000425 |
| Provider Name | Robert J Wasnick |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508057571 PECOS PAC ID: 9739278060 Enrollment ID: I20071210000054 |
| Provider Name | Jeffrey T Dreznick |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1902895436 PECOS PAC ID: 9739260928 Enrollment ID: I20080114000437 |
| Provider Name | Richard P Salzano |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1033157714 PECOS PAC ID: 7911082714 Enrollment ID: I20080304000372 |
| Provider Name | Ayesha Chaudhry |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841450657 PECOS PAC ID: 5496829582 Enrollment ID: I20080814000013 |
| Provider Name | David R Marks |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841486149 PECOS PAC ID: 7315014719 Enrollment ID: I20080926000588 |
| Provider Name | Mark A Marieb |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1508862632 PECOS PAC ID: 1951307768 Enrollment ID: I20081107000650 |
| Provider Name | Jonathan T Simon |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1073565511 PECOS PAC ID: 4385634583 Enrollment ID: I20090210000634 |
| Provider Name | Matthew E Cohen |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1548241490 PECOS PAC ID: 6305842972 Enrollment ID: I20090408000254 |
| Provider Name | Ihor Ponomarenko |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1568491181 PECOS PAC ID: 7012935836 Enrollment ID: I20090429000440 |
| Provider Name | Grace Y Biggs |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1992901508 PECOS PAC ID: 8022162270 Enrollment ID: I20090910000484 |
| Provider Name | Amir Mohammad |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952578809 PECOS PAC ID: 8729124615 Enrollment ID: I20091007000098 |
| Provider Name | Shobha Jagadeesh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174538508 PECOS PAC ID: 5193720571 Enrollment ID: I20091123000384 |
| Provider Name | Olugbenga Arole |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679738017 PECOS PAC ID: 3577631795 Enrollment ID: I20091229000009 |
| Provider Name | Marianne T Cosentino |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1376700609 PECOS PAC ID: 1456423532 Enrollment ID: I20100106000167 |
| Provider Name | Robert Nelson Hyde |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902011885 PECOS PAC ID: 0345381307 Enrollment ID: I20100113000176 |
| Provider Name | Jock D Lawrason |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1629042296 PECOS PAC ID: 7416099809 Enrollment ID: I20100122000726 |
| Provider Name | Richard N Biondi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619931623 PECOS PAC ID: 2769526300 Enrollment ID: I20100219000266 |
| Provider Name | Samuel William Streit |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952467672 PECOS PAC ID: 6800931692 Enrollment ID: I20100901000332 |
| Provider Name | Elliot Keith Mathias |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871669978 PECOS PAC ID: 0547305336 Enrollment ID: I20100901000379 |
| Provider Name | Kenneth Andrew Ward |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386700201 PECOS PAC ID: 5991840787 Enrollment ID: I20100901000438 |
| Provider Name | Frank Peter Swanson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770642100 PECOS PAC ID: 4082759873 Enrollment ID: I20100901000468 |
| Provider Name | Michael C Trager |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811961014 PECOS PAC ID: 9638164791 Enrollment ID: I20100928000522 |
| Provider Name | Madhu S Gowda |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1104856921 PECOS PAC ID: 9537351812 Enrollment ID: I20101005000490 |
| Provider Name | Xiaolan Fei |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1548571037 PECOS PAC ID: 1254523459 Enrollment ID: I20101006000732 |
| Provider Name | Harold Mark Schwartz |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1760432256 PECOS PAC ID: 4789613456 Enrollment ID: I20101112000315 |
| Provider Name | Judith Heller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134191604 PECOS PAC ID: 7911194196 Enrollment ID: I20101214000829 |
| Provider Name | Shyla D Muriel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558387571 PECOS PAC ID: 5597953604 Enrollment ID: I20101215001213 |
| Provider Name | David Moll |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1831186584 PECOS PAC ID: 1153373907 Enrollment ID: I20110121000001 |
| Provider Name | Gerald G Fette |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043396112 PECOS PAC ID: 1456329176 Enrollment ID: I20110207000241 |
| Provider Name | William Johns |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598773160 PECOS PAC ID: 4789869223 Enrollment ID: I20110427000782 |
| Provider Name | Susan Storck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962700252 PECOS PAC ID: 1850576968 Enrollment ID: I20110504000398 |
| Provider Name | John A Farens |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427133354 PECOS PAC ID: 2466486642 Enrollment ID: I20110509000193 |
| Provider Name | Kenneth V Schwartz |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1588727549 PECOS PAC ID: 2466541735 Enrollment ID: I20111117000263 |
| Provider Name | Cynthia Mary Ronan |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1346251659 PECOS PAC ID: 8123295946 Enrollment ID: I20120119000471 |
| Provider Name | Haq Nawaz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841273919 PECOS PAC ID: 3577720952 Enrollment ID: I20120214000276 |
| Provider Name | Maria D Dawe |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659609204 PECOS PAC ID: 0143488569 Enrollment ID: I20120214000858 |
| Provider Name | Kenneth J Garcia |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154374544 PECOS PAC ID: 0244289502 Enrollment ID: I20120330000200 |
| Provider Name | William A Gray |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033402862 PECOS PAC ID: 7911163688 Enrollment ID: I20120724000819 |
| Provider Name | Abraham Fridman |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1205074945 PECOS PAC ID: 2264603455 Enrollment ID: I20120912000411 |
| Provider Name | Sara E Altieri |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518210558 PECOS PAC ID: 2769634955 Enrollment ID: I20121217000116 |
| Provider Name | Seema Dsouza |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851373187 PECOS PAC ID: 1850538372 Enrollment ID: I20130430000582 |
| Provider Name | Colleen L Linari |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972845147 PECOS PAC ID: 2163669953 Enrollment ID: I20130515000503 |
| Provider Name | Mary Ellie Stankus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649222019 PECOS PAC ID: 6901046309 Enrollment ID: I20130708000757 |
| Provider Name | Roman Spivak |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1780889493 PECOS PAC ID: 0941425433 Enrollment ID: I20140625000378 |
| Provider Name | Sarah E Olivier-cabrera |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316237936 PECOS PAC ID: 3779708573 Enrollment ID: I20140711000952 |
| Provider Name | Unknown Bilori |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760762090 PECOS PAC ID: 4284850421 Enrollment ID: I20140724002185 |
| Provider Name | Yiannis Apergis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104176122 PECOS PAC ID: 1153548219 Enrollment ID: I20140813001473 |
| Provider Name | Elizabeth Arbia |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225329238 PECOS PAC ID: 9032337241 Enrollment ID: I20140902000215 |
| Provider Name | Brian Ullman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871902502 PECOS PAC ID: 8426279936 Enrollment ID: I20141027002020 |
| Provider Name | Kathryn Loughlin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588961742 PECOS PAC ID: 9537482070 Enrollment ID: I20150108000770 |
| Provider Name | Leslie Lindgren |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902203037 PECOS PAC ID: 5799001301 Enrollment ID: I20150225002027 |
| Provider Name | Samuel Antwi-boasiako |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1700152063 PECOS PAC ID: 7810208253 Enrollment ID: I20150625001757 |
| Provider Name | Jennifer E Taylor |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700148962 PECOS PAC ID: 9537488531 Enrollment ID: I20151013000271 |
| Provider Name | Stephanie G Pettingle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205258605 PECOS PAC ID: 4587882949 Enrollment ID: I20151016000343 |
| Provider Name | Kanwardeep Arora |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508026428 PECOS PAC ID: 4486728516 Enrollment ID: I20151026000616 |
| Provider Name | Chelsea Teresa Hinchey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891115754 PECOS PAC ID: 7113237769 Enrollment ID: I20151110002834 |
| Provider Name | Brian C Dorcy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912168808 PECOS PAC ID: 2567785256 Enrollment ID: I20160201002891 |
| Provider Name | Michelle L Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144680430 PECOS PAC ID: 4082903448 Enrollment ID: I20160525001569 |
| Provider Name | Amy K Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962956623 PECOS PAC ID: 0244528339 Enrollment ID: I20161005000468 |
| Provider Name | Jenna R Liguori |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134595366 PECOS PAC ID: 5294023800 Enrollment ID: I20161014001074 |
| Provider Name | Katherine Roarty |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407177496 PECOS PAC ID: 1759669658 Enrollment ID: I20161027001698 |
| Provider Name | Manik Garg |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649566332 PECOS PAC ID: 1759509540 Enrollment ID: I20161230000567 |
| Provider Name | Alexis Gopal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477800241 PECOS PAC ID: 6901180603 Enrollment ID: I20170224000046 |
| Provider Name | Deborah E Levenson |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1952406688 PECOS PAC ID: 7416023940 Enrollment ID: I20170628000435 |
| Provider Name | Allison Altenburger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033503230 PECOS PAC ID: 7113239088 Enrollment ID: I20170705001903 |
| Provider Name | Kornelia Thomas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134500051 PECOS PAC ID: 6204107113 Enrollment ID: I20170810000560 |
| Provider Name | Tiana Larsow |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841533858 PECOS PAC ID: 4284921800 Enrollment ID: I20170922001593 |
| Provider Name | Sana Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093133290 PECOS PAC ID: 1850696709 Enrollment ID: I20180108001378 |
| Provider Name | Diana Bytyqi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336665009 PECOS PAC ID: 8921367210 Enrollment ID: I20180111002822 |
| Provider Name | Joanna Reslink |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184134256 PECOS PAC ID: 6103187828 Enrollment ID: I20180220003070 |
| Provider Name | Chi Tang |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1013263870 PECOS PAC ID: 9133492085 Enrollment ID: I20180514002119 |
| Provider Name | Paula Andrea Ortiz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619358124 PECOS PAC ID: 0840547790 Enrollment ID: I20180724000288 |
| Provider Name | Felix Xavier De Jesus Roman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386055069 PECOS PAC ID: 6901104330 Enrollment ID: I20180726000573 |
| Provider Name | Jennifer Chovitch |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689058695 PECOS PAC ID: 8820346299 Enrollment ID: I20180801000584 |
| Provider Name | Swati Srivastava |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316253123 PECOS PAC ID: 2567696693 Enrollment ID: I20180828000335 |
| Provider Name | Daniel Sylvan Lavy |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1578841797 PECOS PAC ID: 3678823523 Enrollment ID: I20180913002618 |
| Provider Name | Sarah Knauf |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588150643 PECOS PAC ID: 9436400322 Enrollment ID: I20180914001265 |
| Provider Name | Sharon Dragich |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1730594821 PECOS PAC ID: 9133470461 Enrollment ID: I20180925002503 |
| Provider Name | Ravinder Boorgula |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326354465 PECOS PAC ID: 9931333234 Enrollment ID: I20181016001433 |
| Provider Name | Teresa Kathryn Spencer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578046611 PECOS PAC ID: 0648523100 Enrollment ID: I20181030002431 |
| Provider Name | Ashish Malhotra |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1750589883 PECOS PAC ID: 5496845844 Enrollment ID: I20181126001746 |
| Provider Name | Cathie Miller |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1194911586 PECOS PAC ID: 5890037691 Enrollment ID: I20190426001166 |
| Provider Name | Shaun Michael Najarian |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568824589 PECOS PAC ID: 5496089948 Enrollment ID: I20190703000199 |
| Provider Name | Scott Arnold Mcintyre |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528554094 PECOS PAC ID: 1951636919 Enrollment ID: I20190712001049 |
| Provider Name | James P Doney |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487017281 PECOS PAC ID: 8123312246 Enrollment ID: I20190827002508 |
| Provider Name | Daniel Lax |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1205254075 PECOS PAC ID: 2466700562 Enrollment ID: I20190905003493 |
| Provider Name | Michael J Naso |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538423488 PECOS PAC ID: 2668701947 Enrollment ID: I20190911003102 |
| Provider Name | Selma Demir |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295003226 PECOS PAC ID: 1456645308 Enrollment ID: I20191104002545 |
| Provider Name | Bianca N Shuster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942853957 PECOS PAC ID: 4587099619 Enrollment ID: I20200120001101 |
| Provider Name | Nelle Manuel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811392830 PECOS PAC ID: 8123454873 Enrollment ID: I20200129000303 |
| Provider Name | Meghan Galli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053945204 PECOS PAC ID: 9931537156 Enrollment ID: I20200320001935 |
| Provider Name | James Koola |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609257757 PECOS PAC ID: 9931537057 Enrollment ID: I20200323003135 |
| Provider Name | Gena M Borgman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164700092 PECOS PAC ID: 3375785280 Enrollment ID: I20200511002029 |
| Provider Name | Vallari Kothari |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1942685292 PECOS PAC ID: 2365759982 Enrollment ID: I20200605000056 |
| Provider Name | Natalie Marte |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972044188 PECOS PAC ID: 3274879507 Enrollment ID: I20200715001723 |
| Provider Name | Mukesh Kumar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104347665 PECOS PAC ID: 5799022596 Enrollment ID: I20200723000304 |
| Provider Name | Alexa Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639787013 PECOS PAC ID: 4385064526 Enrollment ID: I20201009000016 |
| Provider Name | Dariush Jahandideh |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1790282978 PECOS PAC ID: 6709296668 Enrollment ID: I20201104000101 |
| Provider Name | Ellen Ormond Zummo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336741719 PECOS PAC ID: 4284048828 Enrollment ID: I20210122001080 |
| Provider Name | Parnian Kiamanesh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598052946 PECOS PAC ID: 2264746676 Enrollment ID: I20210318000370 |
| Provider Name | Don-andre Jackson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508250952 PECOS PAC ID: 5395080717 Enrollment ID: I20210324001182 |
| Provider Name | Heather Lee Eckenrode |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194242008 PECOS PAC ID: 7012252547 Enrollment ID: I20210405000330 |
| Provider Name | Cynthia Renee Groves |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073046561 PECOS PAC ID: 0749698843 Enrollment ID: I20210408002235 |
| Provider Name | Michael Howard Siev |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1093161895 PECOS PAC ID: 0143510024 Enrollment ID: I20210615002930 |
| Provider Name | Rachel Bernstein |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1063947372 PECOS PAC ID: 4880096957 Enrollment ID: I20210712003337 |
| Provider Name | Sana Hanif |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1841607397 PECOS PAC ID: 6406111491 Enrollment ID: I20210715002993 |
| Provider Name | Barbara M Scarpa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811565237 PECOS PAC ID: 7517361900 Enrollment ID: I20210806001783 |
| Provider Name | Tammie C Carey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205398286 PECOS PAC ID: 6002140407 Enrollment ID: I20210812002352 |
| Provider Name | Aisha Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265939540 PECOS PAC ID: 1658776885 Enrollment ID: I20210825003123 |
| Provider Name | Bharvi Ashok Balar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487187498 PECOS PAC ID: 9739584970 Enrollment ID: I20210825003221 |
| Provider Name | Kristi Browning |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164006128 PECOS PAC ID: 8820496599 Enrollment ID: I20211011000793 |
| Provider Name | Johnson Tsui |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1023376969 PECOS PAC ID: 2062763501 Enrollment ID: I20211029001801 |
| Provider Name | Melissa Francis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194187070 PECOS PAC ID: 5698052645 Enrollment ID: I20211102002208 |
| Provider Name | Jerezem Fegley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700412111 PECOS PAC ID: 2769812817 Enrollment ID: I20211203001896 |
| Provider Name | Fernanda Ponce |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194285486 PECOS PAC ID: 1052792132 Enrollment ID: I20220720003335 |
| Provider Name | Joyce Wamsele |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407238165 PECOS PAC ID: 5294036182 Enrollment ID: I20220902001781 |
| Provider Name | Hannah Perlroth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811657711 PECOS PAC ID: 8820464373 Enrollment ID: I20221025000745 |
| Provider Name | Nicole L Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154092344 PECOS PAC ID: 0547639155 Enrollment ID: I20221202001794 |
| Provider Name | Alessandra Musso |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336866581 PECOS PAC ID: 7517336134 Enrollment ID: I20221202002505 |
| Provider Name | Stephanie Ross |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770212748 PECOS PAC ID: 8628447406 Enrollment ID: I20221219000640 |
| Provider Name | Jonathan Lawrence Quiles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225764582 PECOS PAC ID: 3577936848 Enrollment ID: I20230307002433 |
| Provider Name | Jessica Zaret |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1437376373 PECOS PAC ID: 7618155011 Enrollment ID: I20230322001397 |
| Provider Name | Hassam Arshad Jaffry |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992332324 PECOS PAC ID: 1850766189 Enrollment ID: I20230418002676 |
| Provider Name | Jaime A Goldstein |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1407938582 PECOS PAC ID: 4183727472 Enrollment ID: I20230524000125 |
| Provider Name | Genevieve Cecile Kela |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003466160 PECOS PAC ID: 1153780374 Enrollment ID: I20230706002811 |
| Provider Name | Blerina Petitti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073290441 PECOS PAC ID: 5698138378 Enrollment ID: I20230829000376 |
| Provider Name | Pierre Gordon |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1639306202 PECOS PAC ID: 5597990507 Enrollment ID: I20240213003886 |
Internal Medicine & Pediatrics Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 111 New Haven Ave, Derby, CT 06418 Phone: 203-736-9214 Fax: 203-736-9172 | |
Internacional Clinical Services & Behavior Health Specialist Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6 Iannotti Ln, Derby, CT 06418 Phone: 203-361-9099 |