Individual
CONSTANTINE A MANTHOUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 GRAND ST, 100 GRAND STREET, NEW BRITAIN, CT 06052-2016
(860) 224-5011
Mailing address
100 GRAND ST, 100 GRAND STREET, NEW BRITAIN, CT 06052-2016
(860) 224-5011
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
031195
CT
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
031195
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001311951
—
CT
Enumeration date
03/20/2006
Last updated
07/30/2012
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