Healthcare Provider Details

I. General information

NPI: 1275813156
Provider Name (Legal Business Name): HARTFORD CLINICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 WESTERN BLVD
GLASTONBURY CT
06033-4383
US

IV. Provider business mailing address

17 TALCOTT NOTCH RD
FARMINGTON CT
06032-1818
US

V. Phone/Fax

Practice location:
  • Phone: 860-547-0616
  • Fax: 860-524-2655
Mailing address:
  • Phone: 860-524-2626
  • Fax: 860-677-5029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JOHN L FUNDOCK
Title or Position: VICE PRESIDENT
Credential:
Phone: 860-545-7188