CLEANSLATE MEDICAL GROUP OF CONNECTICUT LLC – NPI #1073057071
Internal Medicine
An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine.
CLEANSLATE MEDICAL GROUP OF CONNECTICUT LLC is a provider located in HARTFORD, CT. NPPES has assigned the NPI number 1073057071 to CLEANSLATE MEDICAL GROUP OF CONNECTICUT LLC on December 09, 2016. It is a Type-2 NPI, indicating this NPI number is associated with an organization. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 207RA0401X from the Health Care Provider Taxonomy code set, which is classified as Internal Medicine, specializing in Addiction Medicine
The NPI profile was previously updated about 3 years ago on Mar 23, 2023. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for CLEANSLATE MEDICAL GROUP OF CONNECTICUT LLC below.
NPI Profile for
CLEANSLATE MEDICAL GROUP OF CONNECTICUT LLC
(more than 9 years ago)
HARTFORD, CT 06105-2630 Phone: (615) 425-0220 Fax: (413) 727-3619
BRENTWOOD, TN 37027-5393 Phone: (615) 425-0220 Fax: (413) 727-3619
CFO
Phone: (615) 425-0220
Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.
A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.
| Taxonomy Classification / Specialization | State | License |
|---|---|---|
| 207RA0401X - Internal Medicine / Addiction Medicine (Primary) |
||
| 207R00000X - Internal Medicine |
The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.