Healthcare Provider Details

I. General information

NPI: 1750125746
Provider Name (Legal Business Name): COMPREHENSIVE ORTHOPEDICS & MUSCULOSKELETAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 LEWIS AVE STE 101
MERIDEN CT
06451-2121
US

IV. Provider business mailing address

455 LEWIS AVE STE 101
MERIDEN CT
06451-2121
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-3280
  • Fax: 203-741-6569
Mailing address:
  • Phone: 203-265-3280
  • Fax: 203-741-6569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHY OLIVEIRA-GAGNON
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 401-573-4317