Healthcare Provider Details

I. General information

NPI: 1114926169
Provider Name (Legal Business Name): SCOTT BERNSTEIN, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RETREAT AVE SUITE 902
HARTFORD CT
06106-2528
US

IV. Provider business mailing address

100 RETREAT AVE SUITE 902
HARTFORD CT
06106-2528
US

V. Phone/Fax

Practice location:
  • Phone: 860-524-1055
  • Fax: 860-524-1058
Mailing address:
  • Phone: 860-524-1055
  • Fax: 860-524-1058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateCT

VIII. Authorized Official

Name: SCOTT BERNSTEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 860-524-1055