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NPI Code Detail

MEDICARE: MDLIVE MEDICAL GROUP TX PLLC

MEDICARE: MDLIVE MEDICAL GROUP TX PLLC
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
1101Y00000XCounselor
2106H00000XMarriage & Family Therapist
3104100000XSocial Worker
4103T00000XPsychologist
52084P0800XPsychiatry Physician

General Provider Information

NPI Number : 1881457109
Entity Type Code : Organization
Provider Name (Legal Business Name) : MDLIVE MEDICAL GROUP TX PLLC
Provider Business Mailing Address
First Line : PO BOX 5006
Second Line :
City : HARTFORD
State : CT
Zip : 06102-5006
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 900 COTTAGE GROVE RD
Second Line :
City : BLOOMFIELD
State : CT
Zip : 06002-2920
Country : US
Telephone Number : 800-400-6354
Fax Number :
Authorized Official
Title or Position : GP PM
Name : SUE-ANN ADRIANS
Credential :
Telephone Number : 800-400-6354
Provider Enumeration Date : 01/31/2024
Last Update Date : 04/10/2026

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