Healthcare Provider Details

I. General information

NPI: 1477257160
Provider Name (Legal Business Name): CONNECTICUT CHILDREN'S MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 03/28/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

V. Phone/Fax

Practice location:
  • Phone: 860-837-5553
  • Fax:
Mailing address:
  • Phone: 860-837-5553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER STEVENS
Title or Position: ASSISTANT GENERAL COUNSEL
Credential:
Phone: 860-837-5553