Provider Demographics
NPI:1598237828
Name:ORTHOPEDIC SURGICAL PARTNERS, P.C.
Entity Type:Organization
Organization Name:ORTHOPEDIC SURGICAL PARTNERS, P.C.
Other - Org Name:HARTFORD ORTHOPEDIC SURGEONS, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-525-4469
Mailing Address - Street 1:1111 CROMWELL AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3454
Mailing Address - Country:US
Mailing Address - Phone:860-525-4469
Mailing Address - Fax:860-999-9305
Practice Address - Street 1:5 FOUNDERS ST STE 202
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2052
Practice Address - Country:US
Practice Address - Phone:860-525-4469
Practice Address - Fax:860-450-7323
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPEDIC SURGICAL PARTNERS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-27
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty