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Organization
CONNECTICUT SURGICAL GROUP, PC
Active
Organization
CONNECTICUT SURGICAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS C MCKELL (CHIEF ADMINISTRATIVE OFFICER)
(860) 524-4326
Entity
Organization
Contact information
Practice address
455 LEWIS AVE, SUITE 210, MERIDEN, CT 06451-2121
(203) 238-1241
(203) 686-0791
Mailing address
17 TALCOTT NOTCH RD, FARMINGTON, CT 06032-1818
(860) 524-2626
(860) 677-5029
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
—
—
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
208800000X
Urology Physician
Primary
—
—
208C00000X
Colon & Rectal Surgery Physician
—
—
213E00000X
Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004139350
—
CT
01
—
50CONNSURCT01
ANTHEM BCBS
CT
Enumeration date
12/06/2007
Last updated
08/11/2010
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