Basic Information
| Provider Information | |||||||||
| NPI: | 1093110777 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARTFORD COUNTY CARDIOLOGY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27 SYCAMORE ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | GLASTONBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060337207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606330500 | ||||||||
| FaxNumber: | 8606335250 | ||||||||
| Practice Location | |||||||||
| Address1: | 27 SYCAMORE ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | GLASTONBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060337207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606330500 | ||||||||
| FaxNumber: | 8606335250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2014 | ||||||||
| LastUpdateDate: | 02/12/2015 | ||||||||
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| AuthorizedOfficialLastName: | FREUND | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8606330500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 026417 | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 026417 | 01 | CT | STATE MEDICAL LICENSE | OTHER |