NPI | 1215436894 |
---|---|
Entity Type | Organization |
Authorized Contact | SUSAN MARTIN Network Executive 860-358-4802 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine |
Additional Taxonomies | 207R00000X Internal Medicine |
363A00000X Physician Assistant | |
363L00000X Nurse Practitioner | |
Enumeration Date | 2018-02-08 |
Last Update Date | 2022-02-07 |