Healthcare Provider Details

I. General information

NPI: 1073839007
Provider Name (Legal Business Name): HARTFORD FERTILITY & REPRODUCTIVE ENDOCRINOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WOODLAND ST SUITE 323
HARTFORD CT
06105-4318
US

IV. Provider business mailing address

21 WOODLAND ST SUITE 323
HARTFORD CT
06105-4318
US

V. Phone/Fax

Practice location:
  • Phone: 860-527-3435
  • Fax: 860-527-9919
Mailing address:
  • Phone: 860-527-3435
  • Fax: 860-527-9919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number18558
License Number StateCT

VIII. Authorized Official

Name: AUGUST C OLIVAR
Title or Position: PHYSICIAN / OWNER
Credential: MD
Phone: 860-527-3435