MEDICARE: WEST HARTFORD PEDIATRICS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	028184	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184622755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST HARTFORD PEDIATRICS, LLC

Provider Business Mailing Address
First Line	:	785 FARMINGTON AVE
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-1673
Country	:	US
Telephone Number	:	860-523-4100
Fax Number	:	860-523-0086

Provider Business Practice Location Address
First Line	:	785 FARMINGTON AVE
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-1673
Country	:	US
Telephone Number	:	860-523-4100
Fax Number	:	860-523-0086

Authorized Official
Title or Position	:	OWNER
Name	:	THOMAS N. FROMSON, M.D.
Credential	:	M.D.
Telephone Number	:	860-523-4100

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	02/03/2014

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