| Connecticut Geriatric Specialty Group, Pc | |
|
1 Abrahms Boulevard West Hartford CT 06117 | |
| (860) 523-3854 | |
| (860) 523-3828 |
| Full Name | Connecticut Geriatric Specialty Group, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 1 Abrahms Boulevard, West Hartford, Connecticut |
| Authorized Official Name and Position | David Houle (VICE PRESIDENT/CFO) |
| Authorized Official Contact | 8605233895 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Connecticut Geriatric Specialty Group, Pc 1 Abrahms Boulevard West Hartford CT 06117 Ph: (860) 523-3854 | Connecticut Geriatric Specialty Group, Pc 1 Abrahms Boulevard West Hartford CT 06117 Ph: (860) 523-3854 |
| NPI Number | 1457573933 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 09/04/2013 |
| Medicare PECOS PAC ID | 0547339236 |
|---|---|
| Medicare Enrollment ID | O20080521000368 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457573933 | NPI | - | NPPES |
| Provider Name | Harold E Sandals |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659348134 PECOS PAC ID: 3577656321 Enrollment ID: I20070910000765 |
| Provider Name | Ava Pannullo |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1578545620 PECOS PAC ID: 2769551464 Enrollment ID: I20080521000516 |
| Provider Name | Elizabeth Esstman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104885565 PECOS PAC ID: 1658440276 Enrollment ID: I20080521000713 |
| Provider Name | Heidi S Haller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629249081 PECOS PAC ID: 3072682608 Enrollment ID: I20080521000741 |
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