Organization
CONNECTICUT SURGICAL GROUP, PC
Active
Organization
CONNECTICUT SURGICAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS C MCKELL (CHIEF ADMINISTRATIVE OFFICER)
(860) 524-4326
Entity
Organization
Contact information
Practice address
65 MEMORIAL RD, SUITE 435, WEST HARTFORD, CT 06107-2434
(860) 547-0616
(860) 524-2655
Mailing address
17 TALCOTT NOTCH RD, FARMINGTON, CT 06032-1818
(860) 547-0616
(860) 524-2655
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
—
—
208600000X
Surgery Physician
—
—
2086S0105X
Surgery of the Hand (Surgery) Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
—
—
2086X0206X
Surgical Oncology Physician
—
—
208800000X
Urology Physician
—
—
208C00000X
Colon & Rectal Surgery Physician
—
—
213E00000X
Podiatrist
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004139350
—
CT
05
—
004169711
—
CT
05
—
004201034
—
CT
05
—
01926310
—
NY
01
—
50CONNSURCT01
ANTHEM BCBS
CT
05
—
9781188
—
MA
Enumeration date
11/21/2005
Last updated
08/11/2010
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