Healthcare Provider Details

I. General information

NPI: 1922037084
Provider Name (Legal Business Name): PLANCHER ORTHOPAEDICS,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 RIVER RD
COS COB CT
06807-2152
US

IV. Provider business mailing address

31 RIVER RD SUITE 100
COS COB CT
06807-2152
US

V. Phone/Fax

Practice location:
  • Phone: 203-863-2003
  • Fax: 203-863-2025
Mailing address:
  • Phone: 212-876-5200
  • Fax: 212-876-4440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number044107
License Number StateCT

VIII. Authorized Official

Name: DR. KEVIN D PLANCHER
Title or Position: PHYSICIAN
Credential: MD
Phone: 203-863-2003