Provider Demographics
NPI:1639155179
Name:HELLER, CYNTHIA B
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:B
Last Name:HELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1559 SULLIVAN AVE
Mailing Address - Street 2:HARTFORD MEDICAL GROUP
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2712
Mailing Address - Country:US
Mailing Address - Phone:860-696-2350
Mailing Address - Fax:860-696-2360
Practice Address - Street 1:1559 SULLIVAN AVE
Practice Address - Street 2:HARTFORD MEDICAL GROUP
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2712
Practice Address - Country:US
Practice Address - Phone:860-696-2350
Practice Address - Fax:860-696-2360
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030644207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001306449Medicaid
CT110003447Medicare ID - Type Unspecified
CT001306449Medicaid
700004941Medicare PIN