Organization
HARTFORD HEALTHCARE MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK BANCROFT VYE (VP ADMINISTRATION)
(860) 972-7858
Entity
Organization
Contact information
Practice address
65 MEMORIAL RD, STE. 430, WEST HARTFORD, CT 06107-2434
(860) 246-2071
Mailing address
1290 SILAS DEANE HWY, WETHERSFIELD, CT 06109-4337
(860) 972-7040
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
10/09/2012
Last updated
07/17/2019
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