Healthcare Provider Details

I. General information

NPI: 1518269091
Provider Name (Legal Business Name): CONNECTICUT VALLEY RADIOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 12/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 WOODLAND ST SUITE 15
HARTFORD CT
06105-2372
US

IV. Provider business mailing address

19 WOODLAND ST SUITE 15
HARTFORD CT
06105-2372
US

V. Phone/Fax

Practice location:
  • Phone: 860-522-1101
  • Fax: 860-549-7092
Mailing address:
  • Phone: 860-522-1101
  • Fax: 860-549-7092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. PATRICIA A PICHETTE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 860-522-1101