Organization
CONNECTICUT SURGICAL GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS C MCKELL (CHIEF ADMINISTRATIVE OFFICER)
(860) 524-4326
Entity
Organization
Contact information
Practice address
17 TALCOTT NOTCH RD, FARMINGTON, CT 06032-1818
(860) 246-2071
(860) 524-2650
Mailing address
17 TALCOTT NOTCH RD, FARMINGTON, CT 06032-1818
(860) 524-2626
(860) 677-5029
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
—
—
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
208600000X
Surgery Physician
Primary
—
CT
2086S0105X
Surgery of the Hand (Surgery) Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
2086X0206X
Surgical Oncology Physician
—
—
208800000X
Urology Physician
—
—
208C00000X
Colon & Rectal Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
213E00000X
Podiatrist
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
364SM0705X
Medical-Surgical Clinical Nurse Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000S02059
CSMS-IPA
CT
05
—
004139350
—
CT
01
—
004169711
DPM# MEDICAID
CT
05
—
004201034
—
CT
05
—
01926310
—
NY
01
—
50CONNSURCT01
ANTHEM BCBS
—
01
—
87090
AETNA
CT
05
—
91416185 00
—
FL
05
—
9781188
—
MA
01
—
G384943
OXFORD
CT
Enumeration date
07/26/2005
Last updated
07/21/2022
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