Organization
CONNECTICUT SURGICAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS C. MCKELL (CAO)
(860) 524-4326
Entity
Organization
Contact information
Practice address
29 HAYNES ST, MANCHESTER, CT 06040-4139
(860) 547-0616
(860) 524-2655
Mailing address
17 TALCOTT NOTCH RD, FARMINGTON, CT 06032-1818
(860) 547-0616
(860) 524-2655
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004139350
—
CT
05
—
004169711
—
CT
05
—
004201034
—
CT
05
—
01926310
—
NY
01
—
50CONNSURG01
ANTHEM
CT
05
—
9781188
—
MA
Enumeration date
02/06/2008
Last updated
08/11/2010
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