Healthcare Provider Details

I. General information

NPI: 1548676877
Provider Name (Legal Business Name): POUNDS, MEDICAL WEIGHT LOSS TRANSFORMATION, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LASALLE RD SUITE 208
WEST HARTFORD CT
06107-2322
US

IV. Provider business mailing address

125 LASALLE RD SUITE 208
WEST HARTFORD CT
06107-2322
US

V. Phone/Fax

Practice location:
  • Phone: 860-906-1289
  • Fax: 860-906-1269
Mailing address:
  • Phone: 860-906-1289
  • Fax: 860-906-1269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VB0002X
TaxonomyObesity Medicine (Obstetrics & Gynecology) Physician
License Number
License Number StateCT

VIII. Authorized Official

Name: MRS. MICHELLE LYNN CAVO
Title or Position: PRESIDENT
Credential: PA-C
Phone: 860-906-1289