Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 1009 | CT |
NPI | 1407929664 |
---|---|
Provider Name | Dr. Bruce D. Caldarone |
First Address | Branford, CT 06405-3020 |
Second Address | Branford, CT 06405-3020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 04/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050001009CT02 | ANTHEM BLUE CROSS (01) | CT |
3759643 | AETNA PROVIDER ID (01) | CT |
CT01009 | LANDMARK PROVIDER (01) | CT |
U49968 | (02) | CT |