Organization
PEDICORP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELLEN GUERTIN (PRACTICE MANAGER)
(860) 231-8453
Entity
Organization
Contact information
Practice address
345 N MAIN ST, SUITE 248, WEST HARTFORD, CT 06117-2515
(860) 231-8453
(860) 523-4061
Mailing address
345 N MAIN ST, SUITE 248, WEST HARTFORD, CT 06117-2515
(860) 231-8453
(860) 523-4061
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Enumeration date
11/07/2007
Last updated
11/07/2007
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