Healthcare Provider Details

I. General information

NPI: 1447201793
Provider Name (Legal Business Name): EASTERN CONNECTICUT HEART ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 MANSFIELD AVE
WILLIMANTIC CT
06226-2041
US

IV. Provider business mailing address

PO BOX 112
WINDSOR CT
06095-0112
US

V. Phone/Fax

Practice location:
  • Phone: 860-456-2898
  • Fax:
Mailing address:
  • Phone: 860-688-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK FISHERKELLER
Title or Position: OWNER
Credential: MD
Phone: 860-688-0033