Healthcare Provider Details

I. General information

NPI: 1881520443
Provider Name (Legal Business Name): COMPREHENSIVE ORTHOPEDICS & MUSCULOSKELETAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 S MAIN ST
CHESHIRE CT
06410-3448
US

IV. Provider business mailing address

863 N MAIN STREET EXT STE 200
WALLINGFORD CT
06492-2434
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-3280
  • Fax: 203-741-6569
Mailing address:
  • Phone: 203-265-3280
  • Fax: 203-741-6569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KATHY OLIVEIRA-GAGNON
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 401-573-4317