Healthcare Provider Details

I. General information

NPI: 1497096416
Provider Name (Legal Business Name): VANESSA CLOSE KLOPFER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2013
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST STE 919 HHC PHYSICIANSCARE, INC (DBA HARTFORD HEALTHCARE MEDIC
HARTFORD CT
06106-5506
US

IV. Provider business mailing address

85 SEYMOUR ST STE 919 HHC PHYSICIANSCARE, INC (DBA HARTFORD HEALTHCARE MEDIC
HARTFORD CT
06106-5506
US

V. Phone/Fax

Practice location:
  • Phone: 860-696-5520
  • Fax:
Mailing address:
  • Phone: 860-696-5520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2901
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: