Provider Demographics
NPI:1770533978
Name:SURGICAL GROUP PC
Entity type:Organization
Organization Name:SURGICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:MATINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-249-8595
Mailing Address - Street 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 2118
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-249-8595
Mailing Address - Fax:860-249-0365
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 2118
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-249-8595
Practice Address - Fax:860-249-0365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004394665Medicaid
CTC01410Medicare PIN