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NPI Code Detail

MEDICARE: RHEUMATOLOGY SPECIALISTS OF CONNECTICUT, INC.

MEDICARE: RHEUMATOLOGY SPECIALISTS OF CONNECTICUT, INC.
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
1207RR0500XRheumatology Physician037380CT

General Provider Information

NPI Number : 1720534811
Entity Type Code : Organization
Provider Name (Legal Business Name) : RHEUMATOLOGY SPECIALISTS OF CONNECTICUT, INC.
Provider Business Mailing Address
First Line : 1504 SULLIVAN AVE
Second Line :
City : SOUTH WINDSOR
State : CT
Zip : 06074-2711
Country : US
Telephone Number : 860-432-8400
Fax Number : 860-432-8430
Provider Business Practice Location Address
First Line : 1504 SULLIVAN AVE
Second Line :
City : SOUTH WINDSOR
State : CT
Zip : 06074-2711
Country : US
Telephone Number : 860-432-8400
Fax Number : 860-432-8430
Authorized Official
Title or Position : OWNER
Name : TIMOTHY QUAN
Credential : MD
Telephone Number : 860-432-8400
Provider Enumeration Date : 08/29/2016
Last Update Date : 06/09/2021

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