Healthcare Provider Details

I. General information

NPI: 1598033342
Provider Name (Legal Business Name): MEP OF BRISTOL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BREWSTER ROAD
BRISTOL CT
06011-0977
US

IV. Provider business mailing address

6880 W SNOWVILLE RD SUITE 210
BRECKSVILLE OH
44141-3254
US

V. Phone/Fax

Practice location:
  • Phone: 860-585-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID KLEIN
Title or Position: MD
Credential:
Phone: 301-944-0034