Basic Information
| Provider Information | |||||||||
| NPI: | 1639164775 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VERSLAND | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2139 SILAS DEANE HIGHWAY | ||||||||
| Address2: | CONNECTICUT GI, PC | ||||||||
| City: | ROCKY HILL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060671327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602574131 | ||||||||
| FaxNumber: | 8602574519 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 LIBERTY SQUARE FLOOR 2 | ||||||||
| Address2: | CONNECTICUT GI, PC | ||||||||
| City: | NEW BRITAIN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060512637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602299688 | ||||||||
| FaxNumber: | 8602295498 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2005 | ||||||||
| LastUpdateDate: | 01/24/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 028335 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 0925918002 | 01 | CT | CIGNA | OTHER | 744458 | 01 | CT | CONNECTICARE | OTHER | 0076300 | 01 | CT | AETNA | OTHER | 001283358 | 05 | CT | MEDICAID | HAS486 | 01 | CT | OXFORD | OTHER | 010028335CT01 | 01 | CT | ANTHEM BC | OTHER |