Healthcare Provider Details

I. General information

NPI: 1396916912
Provider Name (Legal Business Name): SOMERS FAMILY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 BATTLE STREET SUITE 1A
SOMERS CT
06071
US

IV. Provider business mailing address

P.O. BOX 959
SOMERS CT
06071
US

V. Phone/Fax

Practice location:
  • Phone: 860-749-8887
  • Fax: 860-749-7421
Mailing address:
  • Phone: 860-749-8887
  • Fax: 860-749-7421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number039732
License Number StateCT

VIII. Authorized Official

Name: DR. IAN STERLING TUCKER
Title or Position: OWNER
Credential: M.D.
Phone: 860-749-8887