Organization
HARTFORD HEALTHCARE MEDICAL GROUP SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK BANCROFT VYE (VP OF ADMINISTRATION)
(860) 972-7858
Entity
Organization
Contact information
Practice address
2979 MAIN ST, BRIDGEPORT, CT 06606-4284
(203) 382-2100
(203) 382-2110
Mailing address
1290 SILAS DEANE HWY, WETHERSFIELD, CT 06109-4337
(680) 972-9033
(860) 972-7040
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
2084N0400X
Neurology Physician
—
—
213E00000X
Podiatrist
—
—
363A00000X
Physician Assistant
—
—
Other
Enumeration date
11/23/2020
Last updated
11/23/2020
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