Advanced OB-GYN Doctors
Organization Active NPI Obstetrics & Gynecology Physician · West Hartford, CT
NPI 1144549353 · NPPES record last updated Apr 11, 2019
Key facts
- NPI
- 1144549353
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 048077 (CT)
- Legal business name
- ADVANCED OB-GYN DOCTORS
- Practice address
- 20 Deer Run Dr
West Hartford, CT 06107-3140 - Phone
- (860) 313-1486
- NPI assigned
- May 27, 2010
- Organization subpart
- No
Authorized official
- Name
- Dr. Pavani Reddy Pingle, M.D
- Title
- Owner
- Phone
- (860) 313-1486
Practitioners 3
-
Alena Borisovna Eastman, M.D.
-
Pavani Reddy Pingle, M.D
-
Ellen Struzziero, RN, CNM, MSN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110516000094 | CT | Part B Supplier - Clinic/Group Practice | 7214113950 |
Receives reassigned benefits from 2 practitioners Practice locations: Manchester, CT |
National Provider Directory
Locations
146 Hazard Ave
Ste 104
Enfield, CT 06082
Phone (860) 749-7437
646 Farmington Ave FL 2
Hartford, CT 06105
599 Main St
Ste 120
Manchester, CT 06040
599 Main St
Ste 2
Manchester, CT 06040
Phone (860) 643-6440
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician |
207V00000X | 048077 | CT | Yes |
Addresses
Primary practice location
20 Deer Run Dr
West Hartford, CT 06107-3140
Mailing address
20 Deer Run Dr
West Hartford, CT 06107-3140
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All providers in West Hartford, CT · Obstetrics & Gynecology Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 11, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.