Organization
HARTFORD PHYSICIAN SERVICES PC
Active
Other names
Hartford Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENT I STAHL MD (MD/MEDICAL DIRECTOR)
(860) 571-7253
Entity
Organization
Contact information
Practice address
200 RETREAT AVE, 8TH FLOOR- RESEARCH BLDG, HARTFORD, CT 06106
(860) 545-7188
(860) 549-2215
Mailing address
PO BOX 1086, HARTFORD MEDICAL GROUP, WILBRAHAM, MA 01095-7086
(508) 595-0531
(508) 829-5367
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RG0100X
Gastroenterology Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
025147
CT
207T00000X
Neurological Surgery Physician
046916
CT
207X00000X
Orthopaedic Surgery Physician
48268
CT
208000000X
Pediatrics Physician
—
—
2083X0100X
Occupational Medicine Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004092904
—
CT
Enumeration date
11/16/2005
Last updated
11/20/2009
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