Healthcare Provider Details

I. General information

NPI: 1154426377
Provider Name (Legal Business Name): MICHELE TWIGG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 E. GRANBY RD 1ST FLOOR
GRANBY CT
06035
US

IV. Provider business mailing address

2110 SILAS DEANE HWY
ROCKY HILL CT
06067-2313
US

V. Phone/Fax

Practice location:
  • Phone: 860-653-7261
  • Fax: 860-653-6639
Mailing address:
  • Phone: 860-258-3480
  • Fax: 860-571-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number039690
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: