Healthcare Provider Details

I. General information

NPI: 1972527158
Provider Name (Legal Business Name): RICHARD TODD KERSHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR STREET, SUITE 416 HHMG UROLOGY INSTITUTE
HARTFORD CT
06106
US

IV. Provider business mailing address

85 SEYMOUR STREET, SUITE 416 HHMG UROLOGY INSTITUTE
HARTFORD CT
06106
US

V. Phone/Fax

Practice location:
  • Phone: 860-947-8500
  • Fax: 860-524-8643
Mailing address:
  • Phone: 860-947-8500
  • Fax: 860-524-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number042-0010577
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number050730
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number050730
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: