Individual provider Active NPI

Varvara S Mironova, M.D.

  • Surgery Physician
  • Manchester, CT
National Provider Identifier
1114374303
Registry record updated Jun 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
1.076729 Issued in CT
Practice address
29 Haynes St Ste a
Manchester, CT 06040-4139
Phone
(860) 646-8888
NPI assigned
May 18, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 3, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 1.076729 CT Primary

Addresses

Primary practice location

29 Haynes St Ste a
Manchester, CT 06040-4139

Mailing address

29 Haynes St Ste a
Manchester, CT 06040-4139
Phone (860) 646-8888

Other practice location 1

71 Haynes St
Manchester, CT 06040-4131
Phone (860) 646-8888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240112001389 CT Practitioner - General Surgery 1052605797 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
State University of New York Downstate Medical Center, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hartford Healthcare Medical Group Specialists PLLCGroup PAC ID 3173866241, 1,555 clinicians
Prospect CT Medical Foundation IncGroup PAC ID 7416244496, 287 clinicians

Practice addresses (Care Compare)

29 Haynes St
Manchester, CT 06040-4139
Phone (860) 547-0616

71 Haynes St
Manchester, CT 06040-4131
Phone (860) 647-6800

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Melanoma (skin cancer) excision1-10
Removal of tissue12

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1.076729CTMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prospect CT Medical Foundation, Inc. Surgery CurrentSince Jan 1, 2024 Accepting new patients
Medical Access P.C. Current Accepting new patients

Locations

1801 W Olympic Blvd
#2201
Pasadena, CA 91199

175 West Rd
Ellington, CT 06029
Phone (860) 375-5141

18 Haynes St
Uppr
Manchester, CT 06040
Phone (860) 649-7557

71 Haynes St
Manchester, CT 06040
Phone (860) 533-2981

29 Haynes St
Manchester, CT 06040
Phone (860) 533-2903

29 Haynes St
Ste A
Manchester, CT 06040
Phone (860) 646-8888

Interoperability endpoints

  • Direct secure messaging: varvaramironova@mpp.allscriptsdirect.net

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780444800000",
    "number": "1114374303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 HAYNES ST STE A",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060404139",
            "telephone_number": "860-646-8888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 HAYNES ST STE A",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060404139",
            "telephone_number": "860-646-8888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "71 Haynes St",
            "address_purpose": "LOCATION",
            "city": "Manchester",
            "state": "CT",
            "postal_code": "060404131",
            "country_code": "US",
            "telephone_number": "860-646-8888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIRONOVA",
        "first_name": "VARVARA",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-05-18",
        "last_updated": "2026-06-03",
        "certification_date": "2026-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CT",
            "license": "1.076729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, CT

Sources for this page

Verify at the official NPI Registry.