Healthcare Provider Details

I. General information

NPI: 1700171659
Provider Name (Legal Business Name): DR. MICHAEL J HERNON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MICHAEL JOSEPH HERNON MD

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST
HARTFORD CT
06102-8000
US

IV. Provider business mailing address

85 SEYMOUR ST STE 425
HARTFORD CT
06106-5523
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-5000
  • Fax:
Mailing address:
  • Phone: 617-378-1981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number55868
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number55868
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: