Provider Demographics
NPI:1316930951
Name:CIAFONE, RUSSELL A (MD)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:A
Last Name:CIAFONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 HIGHRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEST SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06092-2004
Mailing Address - Country:US
Mailing Address - Phone:860-651-4272
Mailing Address - Fax:
Practice Address - Street 1:66 HIGHRIDGE RD
Practice Address - Street 2:
Practice Address - City:WEST SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06092-2004
Practice Address - Country:US
Practice Address - Phone:860-651-4272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT019512207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTOV4110OtherHEALTH NET
2083482OtherAETNA
CTHAS619OtherOXFORD
00119512204OtherANTHEM BCBS
060052202OtherRAILROAD MEDICARE
CT001195122Medicaid
010019512CT01OtherANTHEM BCBS
CT728452OtherCONNECTICARE
CTOV4110OtherHEALTH NET
010019512CT01OtherANTHEM BCBS
B37869Medicare UPIN