Healthcare Provider Details

I. General information

NPI: 1518353663
Provider Name (Legal Business Name): ROBERT J MCLOUGHLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE DEPT OF SURGERY
FARMINGTON CT
06030-0002
US

IV. Provider business mailing address

263 FARMINGTON AVE DEPT OF SURGERY
FARMINGTON CT
06030-0002
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-2000
  • Fax:
Mailing address:
  • Phone: 860-679-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number75848
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number75848
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: