Provider Demographics
NPI:1720285703
Name:HEBRON MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:HEBRON MEDICAL ASSOCIATES, LLC
Other - Org Name:ROZANN VENTI, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:OPOCENSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-228-9463
Mailing Address - Street 1:269 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:AMSTON
Mailing Address - State:CT
Mailing Address - Zip Code:06231-1403
Mailing Address - Country:US
Mailing Address - Phone:860-228-9463
Mailing Address - Fax:860-228-3766
Practice Address - Street 1:269 CHURCH ST
Practice Address - Street 2:
Practice Address - City:AMSTON
Practice Address - State:CT
Practice Address - Zip Code:06231-1403
Practice Address - Country:US
Practice Address - Phone:860-228-9463
Practice Address - Fax:860-228-3766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT020521207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B38265Medicare UPIN
CTC02649Medicare PIN