MEDICARE: SEAN PATRICK MCGRADE M.D.

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	207R00000X	Internal Medicine Physician	037838	CT

General Provider Information

NPI Number	:	1346205770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN PATRICK MCGRADE M.D.

Provider Business Mailing Address
First Line	:	2 ELIZABETH ST
Second Line	:
City	:	BETHEL
State	:	CT
Zip	:	06801-2100
Country	:	US
Telephone Number	:	203-791-2221
Fax Number	:	203-791-0682

Provider Business Practice Location Address
First Line	:	2 ELIZABETH ST
Second Line	:
City	:	BETHEL
State	:	CT
Zip	:	06801-2100
Country	:	US
Telephone Number	:	203-791-2221
Fax Number	:	203-791-0682

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	06/22/2010

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