Healthcare Provider Details

I. General information

NPI: 1831269729
Provider Name (Legal Business Name): KATHY JEAN KALKBRENNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

39 ELLSWORTH LN
CANTON CT
06019-2642
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-9393
  • Fax:
Mailing address:
  • Phone: 347-819-4735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number14875
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number241381
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number52031
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: