Provider Demographics
NPI:1851643258
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:VP ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:BANCROFT
Authorized Official - Last Name:VYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-972-7858
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:860-547-0616
Mailing Address - Fax:
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:STE. 409
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-547-0616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty