Organization
HEALING EDGE MEDICAL ASSOCIATES LLC
Active
Organization
HEALING EDGE MEDICAL ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD DALE AGNES JR. M.D. (PRESIDENT/PHYSICIAN)
(860) 978-8825
Entity
Organization
Contact information
Practice address
29 KRIPES RD, SUITE M, EAST GRANBY, CT 06026-9669
(860) 413-3883
(860) 413-3884
Mailing address
PO BOX 152, SIMSBURY, CT 06070-0152
(860) 978-8825
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036511
CT
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
Primary
036511
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3097037
—
IL
01
—
J13195
MEDICARE
IL
Enumeration date
01/20/2010
Last updated
06/19/2013
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