Individual
MATTHEW GRISWOLD ELY III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
85 SEYMOUR ST, STE 416, HARTFORD, CT 06106-5501
(860) 947-8500
(860) 524-8643
Mailing address
85 SEYMOUR ST, STE 416, HARTFORD, CT 06106-5501
(860) 947-8500
(860) 524-8643
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
016178
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010016178CT01
ANTHEM BC/BS
CT
01
—
076334
CONNECTICARE
CT
01
—
0V4532
HEALTH NET
CT
01
—
12077
HEALTH NEW ENGLAND
CT
01
—
2053938
AETNA
CT
05
—
3164896
—
MA
01
—
4416097 001
CIGNA
CT
01
—
P2043630
OXFORD
CT
Enumeration date
07/29/2005
Last updated
07/09/2007
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