Healthcare Provider Details

I. General information

NPI: 1083720908
Provider Name (Legal Business Name): MARIAN KELLNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 N MAIN ST SUITE 201
WEST HARTFORD CT
06117-2515
US

IV. Provider business mailing address

345 N MAIN ST SUITE 201
WEST HARTFORD CT
06117-2515
US

V. Phone/Fax

Practice location:
  • Phone: 860-231-2476
  • Fax: 860-231-2480
Mailing address:
  • Phone: 860-231-2476
  • Fax: 860-231-2480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number025220
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: