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General NPI Number Information
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NPI Number | 1982939682
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Entity Type | Organization
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Legal Business Name | CENTRAL CT SURGEONS, LLC
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Dates
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Enumeration Date | 10/14/2009
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Last Update Date | 10/26/2009
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Provider Practice Location Address
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Address Line | 95 WOODLAND ST 2ND FLOOR
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City | HARTFORD
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State | CT
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Zip | 06105-1230
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Country | US
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Telephone | 860-714-7447
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Fax | 860-727-0242
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Provider Business Mailing Address
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Address Line | 95 WOODLAND ST 2ND FLOOR
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City | HARTFORD
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State | CT
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Zip | 06105-1230
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Country | US
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Telephone | 860-714-7447
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Fax | 860-727-0242
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Authorized Official
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Title or Position | OWNER
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Name | DR. CARLOS A BARBA
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Credential | M.D.
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Telephone | 860-714-7447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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