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General NPI Number Information
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NPI Number | 1952589434
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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 | 02/06/2008
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 29 HAYNES ST
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City | MANCHESTER
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State | CT
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Zip | 06040-4139
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Country | US
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Telephone | 860-547-0616
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Fax | 860-524-2655
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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 | 860-547-0616
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Fax | 860-524-2655
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Authorized Official
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Title or Position | CAO
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Name | MR. 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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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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 | 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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