Healthcare Provider Details

I. General information

NPI: 1710809942
Provider Name (Legal Business Name): GREATER HARTFORD PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SILAS DEANE HWY
WETHERSFIELD CT
06109-2134
US

IV. Provider business mailing address

1077 SILAS DEANE HWY # 173
WETHERSFIELD CT
06109-4229
US

V. Phone/Fax

Practice location:
  • Phone: 860-303-7309
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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. LATESHA THOMAS
Title or Position: OWNER
Credential: MD
Phone: 860-303-7309