Provider Demographics
NPI:1891959870
Name:HARTFORD CLINICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:HARTFORD CLINICAL ASSOCIATES, P.C.
Other - Org Name:HCA SPECIALTY GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT, OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FUNDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-545-7188
Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:SUITE #401
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-524-2787
Mailing Address - Fax:860-524-2698
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE #401
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-524-2787
Practice Address - Fax:860-524-2698
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARTFORD CLINICAL ASSOCIATES, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-18
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPENDINGMedicaid
CTPENDINGMedicare PIN