KEITH VOM EIGEN MD (Credential# 178515) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2019. The license expiration date date is February 28, 2021. The license status is ACTIVE.
KEITH VOM EIGEN MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0024751. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2019. The expiration date is February 28, 2021. The business address is 131 Coventry St, Hartford, CT 06112. The current status is active.
| Licensee Name | KEITH VOM EIGEN MD |
| Credential ID | 178515 |
| Credential Number | CSP.0024751 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
131 Coventry St Hartford CT 06112 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 1999-03-01 |
| Effective Date | 2019-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-02-25 |
| Street Address | 131 COVENTRY ST |
| City | HARTFORD |
| State | CT |
| Zip Code | 06112 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Brien M Ohazo | 131 Coventry St, Hartford, CT 06112-1548 | Registered Sanitarian | 2020-04-01 ~ 2021-03-31 |
| Kavita Advani | 131 Coventry St, Hartford, CT 06112-1548 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| City of Hartford · City of Hartford Health Department | 131 Coventry St, Hartford, CT 06112-1548 | Outpatient Clinic | 2017-01-01 ~ 2020-12-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Kelisha Johnson-walton | 48 Irving St., Hartford, CT 06112 | Medication Administration Certification | ~ |
| Sheniqua Jones | 131 Westbourne Pkwy, Hartford, CT 06112 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| June Sumner Ware | 433 Woodland Street, Hartford, CT 06112 | Notary Public Appointment | 2020-06-26 ~ 2025-06-30 |
| Eloise M Gonzales | 620 Garden St Fl 2, Hartford, CT 06112 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Judith Sweeney | 216 Westminster Street, Hartford, CT 06112 | Medication Administration Certification | 2018-06-17 ~ 2020-06-16 |
| Sydia Malcolm | 204 Bluehills Ave, Hartford, CT 06112 | Eyelash Technician | ~ |
| Jessica Mae Wright | 116 Branford Street, Hartford, CT 06112 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Shelia Manning | 140 Vine St 3rd Flr, Hartford, CT 06112 | Hairdresser/cosmetician | 2020-07-01 ~ 2022-06-30 |
| Elaine A Mcglashen-bailey | 261 Blue Hills Avenue, Hartford, CT 06112 | Licensed Practical Nurse | 2020-04-01 ~ 2021-03-31 |
| Tahlya Murray | 210 Burnham Street, Hartford, CT 06112 | Medication Administration Certification | 2020-07-30 ~ 2022-07-29 |
| Find all Licenses in zip 06112 | |||
| City | HARTFORD |
| Zip Code | 06112 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + HARTFORD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Karen Eigen | 355 Maple St, Haworth, NJ 07641-1125 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Keith A Vom Eigen | 37 Hobson Ave, Windsor, CT 06095 | Physician/surgeon | 2020-01-01 ~ 2020-12-31 |
| Keith Hollinger | 55 Nye Rd Ste 101, Glastonbury, CT 06033-1281 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Keith P Cross | 925 Mix Ave Apt 1-h, Hamden, CT 06514 | Controlled Substance Registration for Practitioner | 2007-03-01 ~ 2008-02-29 |
| Keith M Gottesdiener | 900 Fifth Avenue, New York, NY 10021 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Keith J. Falter II | 90 Locust Ave, Danbury, CT 06810-6034 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Keith E Campbell | 415 Killingworth Rd, Higganum, CT 06441 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Keith B Lescale Md | 600 Mamaroneck Ave Ste 110, Harrison, NY 10528-1646 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Keith R Cohen | 649 Willard Ave, Newington, CT 06111-2615 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Keith Corl | 22 Ogden St, Providence, RI 02906-4904 | Controlled Substance Registration for Practitioner | 2019-09-12 ~ 2021-02-28 |
Please comment or provide details below to improve the information on KEITH VOM EIGEN MD.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).