Provider Demographics
NPI:1144370388
Name:MINIMALLY INVASIVE SURGEONS OF GREATER HARTFORD, LLC
Entity type:Organization
Organization Name:MINIMALLY INVASIVE SURGEONS OF GREATER HARTFORD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-241-0870
Mailing Address - Street 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 4301
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-241-0870
Mailing Address - Fax:860-241-8296
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 4301
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-241-0870
Practice Address - Fax:860-241-8296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004251766Medicaid
CTC03429Medicare ID - Type Unspecified