Individual
KEVIN J TALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
85 SEYMOUR ST, SUITE 719, HARTFORD, CT 06106-5501
(860) 522-0604
(860) 522-1761
Mailing address
305 WESTERN BLVD, SUITE 100, GLASTONBURY, CT 06033-4380
(860) 522-0604
(860) 522-1761
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
042086
CT
207UN0901X
Nuclear Cardiology Physician
042086
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001420869
—
CT
01
—
010042086CT01
ANTHEM BCBS
CT
01
—
060001631
MCPIN CT HEART PHYSICIANS
CT
01
—
C00585
PTAN CONS. CARDIOLOGISTS
CT
01
—
CA7937
RAILROAD MEDICARE GROUP #
CT
01
—
P00233421
RAILROAD MEDICARE
CT
Enumeration date
10/25/2005
Last updated
05/20/2015
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