Organization
HARTFORD HEALTHCARE MEDICAL GROUP SPECIALISTS, LLC
Active
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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