Basic Information
| Provider Information | |||||||||
| NPI: | 1528477049 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ESSENT HEALTHCARE OF CONNECTICUT INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 CONTINENTAL PL | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370271041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158449800 | ||||||||
| FaxNumber: | 6158449883 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 HOSPITAL ROAD | ||||||||
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| City: | SHARON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060692096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603644040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2014 | ||||||||
| LastUpdateDate: | 08/08/2014 | ||||||||
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| AuthorizedOfficialLastName: | PAGE | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6158449800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0101X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
No ID Information.