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General NPI Number Information
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NPI Number | 1194915314
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Entity Type | Organization
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Legal Business Name | MEDICAL CENTER OF NORTHEAST CONNECTICUT
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 09/03/2008
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Provider Practice Location Address
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Address Line | 612 HARTFORD PIKE
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City | DAYVILLE
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State | CT
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Zip | 06241-2159
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Country | US
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Telephone | 860-779-0284
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Fax | 860-779-0386
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Provider Business Mailing Address
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Address Line | 612 HARTFORD PIKE
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City | DAYVILLE
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State | CT
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Zip | 06241-2159
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Country | US
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Telephone | 860-779-0284
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Fax | 860-779-0386
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | PAUL J MATTY
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Credential | MD
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Telephone | 860-779-0284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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