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
85 SEYMOUR ST, STE. 409, HARTFORD, CT 06106-5501
(860) 547-0616
Mailing address
PO BOX 417695, BOSTON, MA 02241-7695
(860) 547-0616
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
10/09/2012
Last updated
07/16/2019
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