Healthcare Provider Details

I. General information

NPI: 1033104765
Provider Name (Legal Business Name): DARREN SCOTT TISHLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 WESTERN BLVD
GLASTONBURY CT
06033-1236
US

IV. Provider business mailing address

85 SEYMOUR ST STE 415
HARTFORD CT
06106-5501
US

V. Phone/Fax

Practice location:
  • Phone: 860-246-2071
  • Fax: 860-524-2650
Mailing address:
  • Phone: 860-246-2071
  • Fax: 860-524-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number042514
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: