Healthcare Provider Details

I. General information

NPI: 1982939682
Provider Name (Legal Business Name): CENTRAL CT SURGEONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 WOODLAND ST 2ND FLOOR
HARTFORD CT
06105-1230
US

IV. Provider business mailing address

95 WOODLAND ST 2ND FLOOR
HARTFORD CT
06105-1230
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-7447
  • Fax: 860-727-0242
Mailing address:
  • Phone: 860-714-7447
  • Fax: 860-727-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS A BARBA
Title or Position: OWNER
Credential: M.D.
Phone: 860-714-7447