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
1084 CROMWELL AVE, ROCKY HILL, CT 06067-3445
(860) 246-2071
(860) 524-2650
Mailing address
85 SEYMOUR ST, SUITE 415, HARTFORD, CT 06106-5501
(860) 246-2071
(860) 524-2650
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
—
—
2082S0105X
Surgery of the Hand (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
—
—
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 GROUP NUMBER
CT
01
—
87090
AETNA GROUP NUMBER
CT
05
—
9781188
—
MA
Enumeration date
12/14/2006
Last updated
05/11/2010
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