# PEDICORP, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952581928
- **Authorized official:** MS. ELLEN GUERTIN (PRACTICE MANAGER)
- **Authorized official phone:** (860) 231-8453

## Contact information

- **Practice address:** 345 N MAIN ST, SUITE 248, WEST HARTFORD, CT 06117-2515
- **Practice address phone:** (860) 231-8453
- **Practice address fax:** (860) 523-4061
- **Mailing address:** 345 N MAIN ST, SUITE 248, WEST HARTFORD, CT 06117-2515
- **Mailing address phone:** (860) 231-8453
- **Mailing address fax:** (860) 523-4061

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | NULL | Yes |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/07/2007
- **Last updated:** 11/07/2007