Carl CHI, M.D.
Individual provider Active NPI Psychiatry Physician · Portland, CT
NPI 1982104063 · NPPES record last updated Feb 15, 2018
Key facts
- NPI
- 1982104063
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 18637 (CT)
- Practice address
- 22 Goodrich LN
Portland, CT 06480-1063 - Phone
- (860) 342-4912
- NPI assigned
- Feb 15, 2018
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18637 | CT | MD | Psychiatry Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 18637 | CT | Yes |
Addresses
Primary practice location
22 Goodrich LN
Portland, CT 06480-1063
Mailing address
22 Goodrich LN
Portland, CT 06480-1063
Phone (860) 342-4912
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All providers in Portland, CT · Psychiatry 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 Feb 15, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.