Active NPI
Joseph Anthony Havlicek, MD
- Family Medicine Physician
- Middletown, CT
National Provider Identifier
1609277938
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 011673
- Practice address
- 245 Dekoven Dr
Middletown, CT 06457-3460 - Phone
- (860) 638-4508
- NPI assigned
- Sep 5, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 011673 | CT | Primary |
Addresses
Primary practice location
245 Dekoven Dr
Middletown, CT 06457-3460
Mailing address
245 Dekoven Dr
Middletown, CT 06457-3460
Phone (860) 638-4508
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011673 | CT | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409875200000",
"number": "1609277938",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "245 DEKOVEN DR",
"city": "MIDDLETOWN",
"state": "CT",
"postal_code": "064573460",
"telephone_number": "860-638-4508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "245 DEKOVEN DR",
"city": "MIDDLETOWN",
"state": "CT",
"postal_code": "064573460",
"telephone_number": "860-638-4508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAVLICEK",
"first_name": "JOSEPH",
"middle_name": "ANTHONY",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-09-05",
"last_updated": "2014-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CT",
"license": "011673",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middletown, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.