Healthcare Provider Details

I. General information

NPI: 1134205719
Provider Name (Legal Business Name): ROBERT J FICARA P.A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST SUITE 325
HARTFORD CT
06106-5501
US

IV. Provider business mailing address

PO BOX 33440
HARTFORD CT
06150-3440
US

V. Phone/Fax

Practice location:
  • Phone: 860-522-7181
  • Fax: 860-278-3357
Mailing address:
  • Phone: 860-522-7181
  • Fax: 860-278-3357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number000018
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: