Healthcare Provider Details

I. General information

NPI: 1841542263
Provider Name (Legal Business Name): HARTFORD HEALTHCARE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 12/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 W MAIN ST
AVON CT
06001-4322
US

IV. Provider business mailing address

PO BOX 417695
BOSTON MA
02241-7695
US

V. Phone/Fax

Practice location:
  • Phone: 860-246-2071
  • Fax:
Mailing address:
  • Phone: 860-246-2071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ROCCO ORLANDO III
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 860-263-4155