Healthcare Provider Details

I. General information

NPI: 1710673090
Provider Name (Legal Business Name): TYLER R. HANNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TYLER R. BRINTON JR.

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

10 COLUMBUS BLVD
HARTFORD CT
06106-1976
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-9000
  • Fax:
Mailing address:
  • Phone: 860-837-5564
  • Fax: 860-837-6387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number85734
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: