Individual
DR. CHARLES J LICATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
625 CLARK AVE, BRISTOL, CT 06010-4068
(860) 583-7700
(860) 589-7656
Mailing address
4 FARM SPRINGS RD, PROHEALTH PHYSICIANS, FARMINGTON, CT 06032-2573
(860) 284-5200
(860) 284-5333
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
000359
CT
Other
Enumeration date
08/14/2006
Last updated
07/08/2007
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