Healthcare Provider Details

I. General information

NPI: 1972500304
Provider Name (Legal Business Name): ORTHOPEDIC ASSOCIATES OF HARTFORD,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 SEYMOUR STREET SUITE 100
HARTFORD CT
06106-5501
US

IV. Provider business mailing address

31 SEYMOUR STREET SUITE 100
HARTFORD CT
06106-5501
US

V. Phone/Fax

Practice location:
  • Phone: 860-549-3210
  • Fax: 860-247-3803
Mailing address:
  • Phone: 860-549-3210
  • Fax: 860-247-3803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: LISA M DEMING
Title or Position: CREDENTIALING CODING MANAGER
Credential:
Phone: 860-549-8276