Individual
PACEY PET
Active
Individual
PACEY PET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
30074
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004068508
—
CT
01
—
4329521
AETNA
CT
01
—
730074
CONNECTICARE
—
01
—
9896287
CIGNA
—
01
—
P4302536
OXFORD
—
Enumeration date
02/02/2006
Last updated
03/03/2017
Update your record
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