MEDICARE: COLLINS SURGICAL ASSOCIATES, P.C.

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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1982617437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLINS SURGICAL ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	290 COLLINS ST
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06105-1549
Country	:	US
Telephone Number	:	860-522-1024
Fax Number	:	860-278-4613

Provider Business Practice Location Address
First Line	:	300 HEBRON AVE STE 211
Second Line	:
City	:	GLASTONBURY
State	:	CT
Zip	:	06033-2192
Country	:	US
Telephone Number	:	860-522-1024
Fax Number	:	860-278-4613

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MS. KANDY A PARKER
Credential	:	CPC CPPM
Telephone Number	:	860-522-1024

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	03/08/2021

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