Provider Demographics
NPI:1609823368
Name:KATSETOS, MANNY C (MD)
Entity type:Individual
Prefix:
First Name:MANNY
Middle Name:C
Last Name:KATSETOS
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 1:1 LIBERTY SQ
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-2662
Mailing Address - Country:US
Mailing Address - Phone:860-229-6811
Mailing Address - Fax:
Practice Address - Street 1:1 LIBERTY SQ
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2662
Practice Address - Country:US
Practice Address - Phone:860-229-6811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040147207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT50LEXINGTCT01OtherANTHEM
CT001401471Medicaid
CTI59227Medicare UPIN