Organization
STATE OF CONNECTICUT HEALTH CENTER
Active
Parent organization
STATE OF CONNECTICUT HEALTH CENTER
Other names
Radiology HBP Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF CONNECTICUT HEALTH CENTER
Authorized official
DENIS C LAFRENIERE MD (MEDICAL DIRECTOR)
(860) 679-7503
Entity
Organization
Contact information
Practice address
263 FARMINGTON AVE, RADIOLOGY HBP GROUP, FARMINGTON, CT 06030-0001
(860) 679-7503
(860) 679-1610
Mailing address
263 FARMINGTON AVE, PROVIDER ENROLLMENT - DOWLING SOUTH, FARMINGTON, CT 06030-2212
(860) 679-7503
(860) 679-1610
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500HBX121CT01
ANTHEM BLUE CROSS
CT
Enumeration date
05/27/2008
Last updated
06/15/2012
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