Provider Demographics
NPI:1720289929
Name:RETREAT CARDIOLOGY CONSULTING LLC
Entity Type:Organization
Organization Name:RETREAT CARDIOLOGY CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:T
Authorized Official - Last Name:WILKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-246-8881
Mailing Address - Street 1:100 RETREAT AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2528
Mailing Address - Country:US
Mailing Address - Phone:860-246-8881
Mailing Address - Fax:
Practice Address - Street 1:100 RETREAT AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2528
Practice Address - Country:US
Practice Address - Phone:860-246-8881
Practice Address - Fax:860-246-8891
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RETREAT CARDIOLOGY CONSULTING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-29
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty