Healthcare Provider Details

I. General information

NPI: 1376582445
Provider Name (Legal Business Name): SCOTT RYAN FECTEAU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ASYLUM AVE SUITE 2120
HARTFORD CT
06105
US

IV. Provider business mailing address

1000 ASYLUM AVE SUITE 2120
HARTFORD CT
06105
US

V. Phone/Fax

Practice location:
  • Phone: 860-246-4000
  • Fax: 860-527-6985
Mailing address:
  • Phone: 860-246-4000
  • Fax: 860-527-6985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number037116
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number88373
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number037116
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: