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Organization
OB-GYN ASSOCIATES OF WEST HARTFORD, PC
Active
Organization
OB-GYN ASSOCIATES OF WEST HARTFORD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JACQUELYN GUSTAFSON (PRACTICE MANAGER)
(860) 233-8589
Entity
Organization
Contact information
Practice address
1 NORTHWESTERN DR STE 202, BLOOMFIELD, CT 06002-3400
(860) 233-8589
(860) 236-9636
Mailing address
1 NORTHWESTERN DR STE 202, BLOOMFIELD, CT 06002-3400
(860) 233-8589
(860) 236-9636
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
017368
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001173681
—
CT
01
—
0029111
AETNA/US HEALTHCARE
CT
01
—
010017368CT01
BLUE SHIELD
CT
Enumeration date
11/01/2006
Last updated
12/31/2020
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