Provider Demographics
NPI:1619211182
Name:HARTFORD HEALTHCARE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:HARTFORD HEALTHCARE MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ROCCO
Authorized Official - Middle Name:
Authorized Official - Last Name:ORLANDO
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:860-263-4155
Mailing Address - Street 1:PO BOX 417695
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-7695
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1025 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4229
Practice Address - Country:US
Practice Address - Phone:860-696-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care