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General NPI Number Information
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NPI Number | 1922170786
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Entity Type | Organization
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Legal Business Name | CONNECTICUT SURGICAL GROUP, PC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 03/02/2011
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Provider Practice Location Address
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Address Line | 680 SOUTH MAIN STREET LOWER LEVEL 2
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City | CHESHIRE
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State | CT
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Zip | 06410-3190
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Country | US
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Telephone | 203-238-1241
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Fax | 203-686-0791
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Provider Business Mailing Address
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Address Line | 17 TALCOTT NOTCH RD
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City | FARMINGTON
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State | CT
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Zip | 06032-1818
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Country | US
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Telephone | 860-524-2626
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Fax | 860-677-5029
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Authorized Official
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Title or Position | CHIEF ADMINISTRATIVE OFFICER
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Name | DOUGLAS C. MCKELL
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Credential |
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Telephone | 860-524-4326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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