Healthcare Provider Details

I. General information

NPI: 1184896151
Provider Name (Legal Business Name): GERIATRIC MEDICINE CONSULTANTS HOME VISIT PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2008
Last Update Date: 10/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 BIRCH RD
WEST HARTFORD CT
06119-1009
US

IV. Provider business mailing address

33 BIRCH RD
WEST HARTFORD CT
06119-1009
US

V. Phone/Fax

Practice location:
  • Phone: 860-232-9741
  • Fax:
Mailing address:
  • Phone: 860-232-9741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number031718
License Number StateCT

VIII. Authorized Official

Name: DR. ALISON GROVER
Title or Position: MEMBER
Credential: MD
Phone: 860-232-9741