Healthcare Provider Details

I. General information

NPI: 1427240910
Provider Name (Legal Business Name): FAMILY MEDICINE CENTER,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 E MIDDLE TPKE
MANCHESTER CT
06040-3730
US

IV. Provider business mailing address

PO BOX 112
WINDSOR CT
06095-0112
US

V. Phone/Fax

Practice location:
  • Phone: 860-646-4334
  • Fax:
Mailing address:
  • Phone: 860-646-4334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DENISE LOUISE MACLEOD
Title or Position: OFFICE MANAGER
Credential:
Phone: 860-646-4060