Provider Demographics
NPI:1033104765
Name:TISHLER, DARREN SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:SCOTT
Last Name:TISHLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:STE 415
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-246-2071
Mailing Address - Fax:860-524-2650
Practice Address - Street 1:330 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1236
Practice Address - Country:US
Practice Address - Phone:860-246-2071
Practice Address - Fax:860-524-2650
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042514208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT06-1406459OtherCOLONIAL COOPERATIVE CARE
CT06-1406459OtherGREAT WEST HEALTHCARE
CT06-1406459OtherMULTIPLAN
CT06-1406459OtherPRIVATE HEALTHCARE SYSTEM
CT3621597OtherAETNA
CT001425140Medicaid
CT010042514CT01OtherANTHEM BCBS
CT2V3562OtherHEALTH NET
CT4048166OtherCIGNA
CT06-1406459OtherCORVEL
CT06-1406459OtherUNITED HEALTHCARE
CT06-1406459OtherWELLCARE
MA2084686Medicaid
CT042514OtherCONNECTICARE
CT06-1406459OtherFOCUS
CT06-1406459OtherHMC, PPO
CT06-1406459OtherPIONEER
CT061406459OtherTRICARE
CT34529OtherHEALTH NEW ENGLAND
CTP3301421OtherOXFORD
CT06-1406459OtherCOMMUNITY HEALTH NETWORK
CT06-1406459OtherNORTHEAST HEALTH DIRECT
CT06-1406459OtherFOCUS
MA2084686Medicaid