Healthcare Provider Details

I. General information

NPI: 1972786531
Provider Name (Legal Business Name): PRIMARY CARE FOR WOMEN MARY CUMMINGS SATTI,M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 VISTA DR EASTPORT NORTH BUSINESS PARK
OLD LYME CT
06371-1587
US

IV. Provider business mailing address

8 VISTA DR EASTPORT NORTH BUSINESS PARK
OLD LYME CT
06371-1587
US

V. Phone/Fax

Practice location:
  • Phone: 860-434-8847
  • Fax: 860-434-0428
Mailing address:
  • Phone: 860-434-8847
  • Fax: 860-434-0428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number033112
License Number StateCT

VIII. Authorized Official

Name: DR. MARY CUMMINGS SATTI
Title or Position: OWNER
Credential: M.D.
Phone: 860-434-8847