Healthcare Provider Details

I. General information

NPI: 1346236759
Provider Name (Legal Business Name): HARTFORD RADIATION ONCOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST
HARTFORD CT
06106
US

IV. Provider business mailing address

PO BOX 1962
BRATTLEBORO VT
05302-1962
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-2803
  • Fax: 860-545-4002
Mailing address:
  • Phone: 770-693-2622
  • Fax: 770-693-5821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number StateCT

VIII. Authorized Official

Name: SUSAN KIM
Title or Position: TREASURER
Credential:
Phone: 860-972-2803