Kitima Boonvisudhi (NPI# 1134198005, PAC ID# 1456434091) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is GENERAL SURGERY.
| Nation Provider ID (NPI) | 1134198005 |
| PAC ID by PECOS | 1456434091 |
| Professional Enrollment ID | I20160428000015 |
| Full Name | Kitima Boonvisudhi |
| Organization Legal Name | NORTHEAST MEDICAL GROUP INC |
| Address |
40 Boston Post Rd Waterford CT 06385-2424 |
| Phone Number | 8602714949 |
| Gender | F |
| Medical School | UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE |
| Graduation Year | 1994 |
| Primary Specialty | GENERAL SURGERY |
| Group Practice PAC ID | 1254233836 |
| Number of Group Practice Members | 1014 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 070007 | LAWRENCE & MEMORIAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 40 Boston Post Rd, Waterford, CT 06385-2424 | 8602714949 | NORTHEAST MEDICAL GROUP INC |
| Organization Legal Name | NORTHEAST MEDICAL GROUP INC |
| Physicians | 1113 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Daniel J Razzano | Internal Medicine | Northeast Medical Group Inc | 1 Long Wharf Dr, New Haven, CT 06511-5991 |
| Irene Besser | Certified Nurse Midwife (cnm) | Northeast Medical Group Inc | 3 Shaws Cv, New London, CT 06320-4952 |
| Ang Zhang | Internal Medicine | Northeast Medical Group Inc | 50 Gaylord Farm Rd, Wallingford, CT 06492-2828 |
| Carolyn Brown | Nurse Practitioner | Northeast Medical Group Inc | 112 Quarry Rd, Suite 400, Trumbull, CT 06611-4877 |
| Nicole Parry | Nurse Practitioner | Northeast Medical Group Inc | 999 Silver Lane, Trumbull, CT 06611-5343 |
| Amanda L Hall | Nurse Practitioner | Northeast Medical Group Inc | 1308 Chapel St, New Haven, CT 06511-4515 |
| Murielle Exantus | Nurse Practitioner | Northeast Medical Group Inc | 422 Highland Ave, Cheshire, CT 06410-2526 |
| Brittany L Provenzano | Nurse Practitioner | Northeast Medical Group Inc | 887 Bridgeport Ave, Shelton, CT 06484-7602 |
| Pradnya Velankar | Cardiovascular Disease (cardiology) | Northeast Medical Group Inc | 230 Waterford Pkwy S, Waterford, CT 06385-1219 |
| Andrew J. Anson | Psychiatry | Northeast Medical Group Inc | 111 Beach Rd, Fairfield, CT 06824-6668 |
| Street Address |
40 BOSTON POST RD |
| City | WATERFORD |
| State | CT |
| Zip | 06385-2424 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Brian C Cambi | Interventional Cardiology | Northeast Medical Group Inc | 196 Pkwy S, Suite 103, Waterford, CT 06385 |
| Anthony D Quinn | Urology | Hartford Healthcare Medical Group Specialists LLC | 196 Pkwy S, Suite 201, Waterford, CT 06385 |
| Costin Nicolae Ionescu | Interventional Cardiology | Northeast Medical Group Inc | 196 Pkwy S, Suite 103, Waterford, CT 06385 |
| Jude F Clancy | Cardiac Electrophysiology | Northeast Medical Group Inc | 196 Pkwy S, Suite 103, Waterford, CT 06385 |
| Richard A Fraser | Urology | Hartford Healthcare Medical Group Specialists LLC | 196 Pkwy S, Suite 201, Waterford, CT 06385 |
| Rachelle Darout | Family Medicine | Northeast Medical Group Inc | 196 Pkwy S, Suite 103, Waterford, CT 06385 |
| Carlos I Mena-hurtado | Interventional Cardiology | Northeast Medical Group Inc | 196 Pkwy S, Suite 103, Waterford, CT 06385 |
| David F Crawley | Urology | Hartford Healthcare Medical Group Specialists LLC | 196 Pkwy S, Suite 201, Waterford, CT 06385 |
| Mark Somers | Cardiovascular Disease (cardiology) | Northeast Medical Group Inc | 196 Pkwy S, Suite 103, Waterford, CT 06385 |
| Valerie B Popkin | Cardiovascular Disease (cardiology) | Northeast Medical Group Inc | 196 Pkwy S, Suite 103, Waterford, CT 06385 |
| Find all physicians in zip 06385 | |||
| City | WATERFORD |
| Zip Code | 06385 |
| Specialty | GENERAL SURGERY |
| City + Specialty | WATERFORD + GENERAL SURGERY |
Please comment or provide details below to improve the information on Kitima Boonvisudhi.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.