Healthcare Provider Details

I. General information

NPI: 1619901378
Provider Name (Legal Business Name): KATHLEEN M ABBOTT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 BLUE HILLS AVE
HARTFORD CT
06112-1513
US

IV. Provider business mailing address

490 BLUE HILLS AVE
HARTFORD CT
06112-1513
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-2647
  • Fax: 860-714-8517
Mailing address:
  • Phone: 860-714-2647
  • Fax: 860-714-8517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number040009
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: