Healthcare Provider Details

I. General information

NPI: 1285729780
Provider Name (Legal Business Name): MANSFIELD PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12A LEDGEBROOK DRIVE
MANSFIELD CENTER CT
06250
US

IV. Provider business mailing address

12A LEDGEBROOK DRIVE
MANSFIELD CENTER CT
06250
US

V. Phone/Fax

Practice location:
  • Phone: 860-423-2960
  • Fax: 860-423-3719
Mailing address:
  • Phone: 860-423-2960
  • Fax: 860-423-3719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CRAIG R ELLIOTT
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 860-423-2960