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
—
—
106H00000X
Marriage & Family Therapist
—
—
163W00000X
Registered Nurse
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207VX0201X
Gynecologic Oncology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
208M00000X
Hospitalist Physician
—
—
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
05/16/2016
Last updated
03/15/2021
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