Organization
HARTFORD HEALTHCARE MEDICAL GROUP SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK BANCROFT VYE (VP ADMINISTRATION)
(860) 972-7858
Entity
Organization
Contact information
Practice address
1025 SILAS DEANE HWY, WETHERSFIELD, CT 06109-4223
(860) 696-2296
Mailing address
1290 SILAS DEANE HWY, WETHERSFIELD, CT 06109-4337
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
07/17/2019
Last updated
07/17/2019
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