Healthcare Provider Details

I. General information

NPI: 1245407352
Provider Name (Legal Business Name): BERLIN PEDIATRIC ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

742 WORTHINGTON RDG SUITE A
BERLIN CT
06037-3233
US

IV. Provider business mailing address

742 WORTHINGTON RDG SUITE A
BERLIN CT
06037-3233
US

V. Phone/Fax

Practice location:
  • Phone: 860-829-7337
  • Fax: 860-829-2295
Mailing address:
  • Phone: 860-829-7337
  • Fax: 860-829-2295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number041963
License Number StateCT

VIII. Authorized Official

Name: DR. MATTEO JOSEPH LOPREIATO
Title or Position: SOLE MEMBER
Credential: MD
Phone: 860-829-7337