Provider Demographics
NPI:1649569641
Name:LITCHFIELD COUNTY ORTHOPEDIC & SPINE PC
Entity Type:Organization
Organization Name:LITCHFIELD COUNTY ORTHOPEDIC & SPINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:S
Authorized Official - Last Name:GARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-361-6650
Mailing Address - Street 1:PO BOX 757
Mailing Address - Street 2:622 BANTAM RD
Mailing Address - City:BANTAM
Mailing Address - State:CT
Mailing Address - Zip Code:06750-0757
Mailing Address - Country:US
Mailing Address - Phone:860-361-6650
Mailing Address - Fax:
Practice Address - Street 1:622 BANTAM ROAD
Practice Address - Street 2:
Practice Address - City:BANTAM
Practice Address - State:CT
Practice Address - Zip Code:06750-0757
Practice Address - Country:US
Practice Address - Phone:860-361-6650
Practice Address - Fax:860-361-6654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044118174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty