Healthcare Provider Details

I. General information

NPI: 1255336970
Provider Name (Legal Business Name): MARGARET GRUNNET M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-0001
US

IV. Provider business mailing address

65 KANE ST
WEST HARTFORD CT
06119-2110
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-2980
  • Fax: 860-679-4334
Mailing address:
  • Phone: 860-523-6421
  • Fax: 860-523-3021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number022371
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: