Provider Demographics
NPI:1265558001
Name:HARTFORD NEUROLOGY, LLC
Entity type:Organization
Organization Name:HARTFORD NEUROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:G
Authorized Official - Last Name:CAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-522-4429
Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-522-4429
Mailing Address - Fax:860-249-6742
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 800
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-522-4429
Practice Address - Fax:860-249-6742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004160967Medicaid
CTC02006Medicare ID - Type Unspecified