MEDICARE: BETHEL PRIMARY CARE CENTER LLC

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	207Q00000X	Family Medicine Physician	000438	CT

General Provider Information

NPI Number	:	1376095646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHEL PRIMARY CARE CENTER LLC

Provider Business Mailing Address
First Line	:	6 STONY HILL RD
Second Line	:
City	:	BETHEL
State	:	CT
Zip	:	06801-1053
Country	:	US
Telephone Number	:	203-456-8000
Fax Number	:	203-917-4923

Provider Business Practice Location Address
First Line	:	6 STONY HILL RD
Second Line	:
City	:	BETHEL
State	:	CT
Zip	:	06801-1053
Country	:	US
Telephone Number	:	203-456-8000
Fax Number	:	203-917-4923

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MATTHEW DAVID AMARA
Credential	:	D.O.
Telephone Number	:	203-456-8000

Provider Enumeration Date	:	11/02/2016
Last Update Date	:	11/02/2016

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