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CONNECTICUT SURGICAL GROUP, PC

Physicians Plastic Surgery

Provider NPI: 1639231046

Organization Information:
Organization Name:  CONNECTICUT SURGICAL GROUP, PC
Organization is not Subpart
Authorized Official:  DOUGLAS C MCKELL  CHIEF ADMINISTRATIVE OFFICER  860-524-4326

Practice Location:
1084 CROMWELL AVE  ROCKY HILL, CT 06067-3445 US
Tel: 860-246-2071  Fax: 860-524-2650

Business Mailing Address:
85 SEYMOUR ST SUITE 415 HARTFORD, CT 06106-5501 US
Tel: 860-246-2071  Fax: 860-524-2650

NPI Information:
NPI: 1639231046
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N208200000XPhysicians
Plastic Surgery
N2082S0105XPhysicians
Plastic Surgery
N208600000XPhysicians
Surgery
N2086S0105XPhysicians
Surgery
N2086S0122XPhysicians
Surgery
N2086X0206XPhysicians
Surgery
N208800000XPhysicians
Urology
N213E00000XPodiatric Medicine & Surgery Service Providers
Podiatrist
N213ES0103XPodiatric Medicine & Surgery Service Providers
Podiatrist
Y332B00000XSuppliers
Durable Medical Equipment & Medical Supplies

Other Provider Identifiers:

IssuerNumberStateType
004139350CT05
004169711CT05
01926310NY05
9781188MA05
ANTHEM BCBS GROUP NUMBER50CONNSURCT01CT01
AETNA GROUP NUMBER87090CT01
004201034CT05



American Medical Association 2012 taxonomy code information

Code: 332B00000X

Type:

Classification:



Definition:



MEDICAL JOBS CT - Page 1

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