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Organization
PROSPECT CT MEDICAL FOUNDATION, INC.
Active
Organization
PROSPECT CT MEDICAL FOUNDATION, INC.
Active
Other names
medical group
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT JON ELDERS (SECRETARY)
(714) 788-1249
Entity
Organization
Contact information
Practice address
71 HAYNES ST, MILLER BLDG., FLOOR G, MANCHESTER, CT 06040-4131
(860) 533-2981
(860) 533-2975
Mailing address
71 HAYNES ST, MILLER BLDG., FLOOR G, MANCHESTER, CT 06040-4131
(860) 533-2981
(860) 533-2975
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
NULL
106H00000X
Marriage & Family Therapist
—
—
163W00000X
Registered Nurse
—
NULL
163W00000X
Registered Nurse
—
—
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
NULL
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
NULL
207RG0100X
Gastroenterology Physician
—
—
207VX0201X
Gynecologic Oncology Physician
—
NULL
207VX0201X
Gynecologic Oncology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
NULL
207X00000X
Orthopaedic Surgery Physician
—
—
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
NULL
2086S0129X
Vascular Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
NULL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
208M00000X
Hospitalist Physician
—
NULL
208M00000X
Hospitalist Physician
—
—
363AM0700X
Medical Physician Assistant
—
NULL
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
05/16/2016
Last updated
03/15/2021
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