Healthcare Provider Details

I. General information

NPI: 1760690101
Provider Name (Legal Business Name): SAINT FRANCIS CARE MEDICAL GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WOODLAND ST SAINT FRANCIS CARE MEDICAL GROUP PC
HARTFORD CT
06105-1208
US

IV. Provider business mailing address

1000 ASYLUM AVE SUITE 4309
HARTFORD CT
06105-1770
US

V. Phone/Fax

Practice location:
  • Phone: 860-979-1880
  • Fax:
Mailing address:
  • Phone: 860-714-1325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number StateCT

VIII. Authorized Official

Name: SURENDRA KHERA
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 860-714-4361