Healthcare Provider Details

I. General information

NPI: 1205495850
Provider Name (Legal Business Name): RADIOLOGY ASSOCIATES OF HARTFORD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 12/28/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673 COTTAGE GROVE RD
BLOOMFIELD CT
06002-3033
US

IV. Provider business mailing address

1000 ASYLUM AVE STE 3201E
HARTFORD CT
06105-1714
US

V. Phone/Fax

Practice location:
  • Phone: 860-969-6400
  • Fax: 860-969-6392
Mailing address:
  • Phone: 860-969-6400
  • Fax: 860-969-6391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHAEL T. TWOHIG
Title or Position: PRESIDENT / AUTHORIZED OFFICIAL
Credential:
Phone: 860-969-6400