Provider Demographics
NPI:1710017439
Name:ORTHOPEDIC SURGICAL PARTNERS, P.C.
Entity Type:Organization
Organization Name:ORTHOPEDIC SURGICAL PARTNERS, P.C.
Other - Org Name:HARTFORD ORTHOPEDIC SURGEONS, P.C.
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:860-278-8032
Practice Address - Street 1:1111 CROMWELL AVE STE 404
Practice Address - Street 2:BLDG 4
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-3455
Practice Address - Country:US
Practice Address - Phone:860-525-4469
Practice Address - Fax:860-278-8032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C01240Medicare PIN
CTS52024Medicare UPIN
CT6440710004Medicare NSC
CTB39643Medicare UPIN
CTB38580Medicare UPIN
CTP71800Medicare UPIN
CT6440710002Medicare NSC
CT6440710001Medicare NSC
CTF83928Medicare UPIN
CT6440710003Medicare NSC