Individual
MR. THOMAS KUCHARCHIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
481 GOLD STAR HWY, SUITE 100, GROTON, CT 06340-6702
(860) 446-8858
(860) 405-2140
Mailing address
635 MAIN ST, ATTN: CREDENTIALING DPT, MIDDLETOWN, CT 06457-2718
(860) 347-6971
(860) 638-6601
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25896
CT
207Q00000X
Family Medicine Physician
9785
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001258961
—
CT
01
—
010025896CT01
BCBS
—
01
—
030897
HEALTHNET
CT
05
—
097852
—
SC
01
—
761101
CONNECTICARE
—
01
—
NLP057
OXFORD
CT
01
—
SC11353402
MEDICARE PTAN
SC
Enumeration date
09/01/2006
Last updated
08/29/2013
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