MEDICARE: KRISTIN MCGREGOR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	036875	CT
2	208000000X	Pediatrics Physician	036875	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	010036875CT01	OTHER	CT	ANTHEM BLUE SHIELD

General Provider Information

NPI Number	:	1235152307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN MCGREGOR MD

Provider Business Mailing Address
First Line	:	57 JOLLEY DR
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3062
Country	:	US
Telephone Number	:	860-243-5225
Fax Number	:	860-769-6757

Provider Business Practice Location Address
First Line	:	57 JOLLEY DR
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3062
Country	:	US
Telephone Number	:	860-243-5225
Fax Number	:	860-769-6757

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	06/22/2021

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